Majority of the healthcare providers in US struggle while dealing with health insurance claim denials. Getting frequent claims denial from the insurers can be quite frustrating, and can lead to major losses if proper action is not taken.
Industry Standards State
Top Reasons Health Insurers Deny Physicians’ Billed Services
|Private Health Insurers||% of Denied Services||Medicare||% of Denied Services|
|Non-covered Service||50.00%||Non-covered Service||31.00%|
|Patient Not Eligible for Benefits||25.00%||Claim Lacks Information||23.00%|
|Claim Lacks Information||9.00%||Claim Sent to Wrong Health Insurer||16.00%|
|Prior Authorization Required||5.00%||Not Medically Necessary||14.00%|
|Claim Sent to Wrong Health Insurer||4.00%||Patient Not Eligible for Benefits||13.00%|
|Documentation Required||3.00%||Documentation Required||1.00%|
Source: National Healthcare Exchange Services 200
Moreover nearly 23% of the claims submitted by the physicians to commercial health insurers are not paid. Of these, most common reason for claims denial is patient deductibles.
Some of the common reasons leading to patient deductibles-
Several claim rejects and edits can behave as a barrier to successfully getting claims into the adjudications system. Due to this, doctors have to spend hours correcting the claims and resending it to the insurance companies. According to the AMA research, doctors’ offices spend an average of 20-plus hours each week dealing with “claim edits.”
How can physicians reduce unexpected denials and rejection?
Some of the most common reasons are mentioned below, which can help you in filing correct claims and submit them successfully.
Improve denials management with MBC’s complete billing solution!
MBC's experienced professionals can help ensure clean claim submissions through their immense experience in documentation and coding-
|Complete Data Analysis||To identify the denial trends not apparent in the aggregate data|
|Charge Overview||To identify loopholes in procedures documented and check for misplaced and missed charges|
|Training Assistance||To facilitate basic coding skills to staff to assess medical necessity|
|Back-End Editing||To identify claims with codes that might not support the medical necessity|
|Documentation improvement||To address deficiencies not covered by the clinical and coding professionals|
|Releasing Information||To provide copies of patient information to the insurer on time when requested|
All these actions help reduce denied claims and increase your practice efficiency and revenue.
Medicalbillersandcoders.com has been successfully helping clients improve denials management and increase revenue. MBC is the largest consortium of billers and coders providing medical billing across all 50 US States in varied specialties.
MBC constantly aims to stop inaccurate claim submissions by vigilant monitoring of claims submitted to improve accuracy, compliance and productivity.