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Family Practice Billing Without the Pain of denials and Rejection

The Truth about Denied or Rejected Claims in Family Practice Billing

You might think a single denied claim is just a minor setback for your family practice billing. However, the overall impact can be much bigger than you can imagine. 

Did you know that almost 20% of all claims are denied, and up to 60% of returned claims are never resubmitted? The financial impact is significant––with the cost to rework a denied claim averaging $25 per claim for practices and $181 per claim for hospitals.

Did you know that almost 20% of all claims are denied, and up to 60% of returned claims are never resubmitted? The financial impact is significant––with the cost to rework a denied claim averaging $25 per claim for practices and $181 per claim for hospitals. 

(Source: JOURNAL of AHIMA)

Denied or rejected claims in family practice billing disturb cash flow and patient care. Worry not! This article will help you streamline your family practice billing with straightforward strategies and boost your revenue.

Understanding Claim Denials vs. Rejections in Family Practice Billing

Knowing the difference between denied and rejected claims is crucial for efficient family practice billing. Denied claims have been processed by the insurer but considered unpayable due to errors like:

  • Provider credentialing issues
  • Non-covered services
  • Medical necessity not established
  • Missing referrals or provider data
  • Incorrect patient information

These denied claims require detailed follow-up to correct and resubmit. Rejected claims, on the other hand, contain errors detected before processing, such as:

  • Coding errors
  • Mismatched procedure and ICD-10 codes
  • Incorrect patient information

These errors can be corrected and resubmitted more easily.

10 Expert Tips for Reducing Claim Denials & Rejection

Reducing claim denials and rejections is crucial for maintaining a healthy revenue stream in your family practice. Here are some effective strategies to minimize these issues:

  1. Ensure Accurate Patient Information

Verify patient details at every visit to ensure correct names, addresses, and insurance information. Even minor errors can lead to claim rejections.

  1. Stay Up-to-Date with Insurance Policies

Stay updated with the insurance policies and coverage details for your patients. Knowing what services are covered under different plans can prevent denials due to non-covered services.

  1. Verify Eligibility and Benefits

Always verify the patient’s eligibility and benefits with their insurance carrier before providing services. This step helps identify coverage limitations and reduces the risk of claim denials.

  1. Educate and Train Staff

Invest in regular training for your billing and administrative staff. They should know the latest coding changes, insurance guidelines, and common reasons for claim denials.

  1. Use Correct Coding Practices

Ensure that all procedures and diagnoses are coded accurately. Use the most current ICD-10, CPT, and HCPCS codes to avoid coding errors that lead to claim rejections and denials.

  1. Conduct Regular Chart Audits

Perform routine patient charts and billing records audits to identify and correct errors before claims are submitted. This proactive approach can significantly reduce the number of rejected claims.

  1. Implement Pre-Submission Claims Scrubbing

Use automated claims scrubbing tools that review claims for errors before submission. These tools can identify issues like coding mismatches, incomplete information, and eligibility problems.

  1. Follow Up on Claims Promptly

Establish a system for monitoring and following up on claims. Prompt follow-up on denied claims can ensure that they are corrected and resubmitted quickly, reducing the time to payment.

  1. Maintain Clear Documentation

Accurate and thorough documentation is essential. Ensure that all patient visits, procedures, and diagnoses are well-documented to support the claims submitted.

  1. Outsource Family Practice Billing and Coding Services

Consider outsourcing your billing and coding operations to a professional service like Medical Billers and Coders (MBC). Professional billers can help ensure that claims are accurately coded and submitted––reducing the likelihood of errors and increasing your practice’s revenue.

Legacy AR - Medical Billers and Coders

How MBC Can Help Streamline Family Practice Billing:

Medical Billers and Coders (MBC) specialize in streamlining the billing process for family practices. Here’s how MBC can benefit your practice:

  • Cost Savings: Achieve visible cost savings through our professional family practice billing and coding services.
  • Revenue Boost: Experience a substantial 10-15% growth in revenue with our expertise.
  • Streamlined Claims: Ensure clean claims submission, maximizing revenue generation.
  • Advanced Tools: Leverage our AI-based solutions and advanced billing software for efficient revenue cycle management.
  • Compliance Assurance: Stay updated with industry regulations and coding guidelines to maintain compliance.

Ready to Enhance Your Family Practice Revenue?

Contact MBC today for family practice billing and coding services and experience a visible revenue boost in your practice. Call us at 888-357-3226 or email us at info@medicalbillersandcoders.com.

FAQs

1. What is the difference between a denied claim and a rejected claim in family practice billing?

A denied claim is one that has been processed by the insurer but deemed unpayable due to errors such as credentialing issues or lack of medical necessity. A rejected claim, on the other hand, contains errors identified before processing, like coding mistakes or incorrect patient information, and can be resubmitted after correction.

2. How can family practices reduce the likelihood of claim denials and rejections?

To reduce claim denials and rejections, family practices should verify patient information, stay up to date with insurance policies, use accurate coding practices, perform regular chart audits, and implement pre-submission claims scrubbing. Prompt follow-up on denied claims is also crucial for resubmission.

3. Why is accurate coding important in family practice billing?

Accurate coding ensures that diagnoses and procedures are properly represented, reducing the chance of errors that lead to claim rejections or denials. Using current ICD-10, CPT, and HCPCS codes is critical to avoiding coding discrepancies and ensuring timely payments.

4. What are the financial impacts of denied claims on family practices?

Denied claims can be costly for family practices, with the average cost to rework a denied claim being around $25. Failing to resubmit claims results in lost revenue and can negatively affect the practice’s cash flow and patient care.

5. How can outsourcing family practice billing services improve revenue?

Outsourcing family practice billing services to a professional company like Medical Billers and Coders (MBC) improves accuracy, speeds up claims submission, and ensures compliance with the latest regulations. This leads to reduced denials, increased revenue, and allows physicians to focus more on patient care rather than administrative tasks.

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