Medical Claims denied is something we never wanted to see, which is equally frustrating and need to tackle the medical claim process again which is time-consuming along with it reduces your revenue for the practice over time.
A recent survey suggested that an average medical practices spend over $17,000 on the calls, works on claim reworking, get to do the investigation again which is an additional dollar that takes up and not to forget the time that is spent after it. Medical billing is extremely challenging, and there is no reason why the medical claim status of reimbursement can’t improve. The denials can be minimized and can achieve a better ROI on your medical claim status.
This survey showed that 85% of claim denials are preventable. Some of the most common claim denial reasons can be rectified by correcting claims management workflows, including claims submission and patient registration procedures.
Below Identified The Following Most Common Medical Claim Denial Reasons:
- Missing Information, Including Absent Or Incorrect Patient Demographic Information And Technical Errors
- Duplicate Claim Submission
- Service Previously Adjudicated
- Services Not Covered By Payer
- Time Limit For Claim Submission Expired
Automating Everything You Can
Automation comes with end number of benefits especially when it is integrated with your present system. To keep up with the codes and ever-changing medical billing policies can be exhausting but with a professional medical billing company, you can outsource or implement software that takes care of these headaches.
This cuts down on your research time, allowing your billing team to spend more time double-checking claims to make sure they meet every single requirement.
Another benefit of automation is that software systems can streamline the documentation process and flag items that need to be resolved before claims are submitted. This means that your whole team can become aware of what needs to happen in order to get reimbursed; cutting down on the time the billing team needs to spend figuring out what is missing and tracking down the necessary parties.
Thorough Investigate The Cause Of The Denials
Once the claim is denied, you’re billing staff or service can’t just overlook it. Follow-up is absolutely important in order to lessen the blow of claim denials. It may take some time, but it’s well worth it to research the cause of procedure denials. You’d be surprised how many millions of dollars are left improperly reimbursed every year due to the fact that the billing staff didn’t properly investigate denied claims.
Stay Updated With The Medical / Healthcare Industry Changes
Even if you have the software or have outsourced your medical coding and billing work which will flag inaccuracies, your billing staff and everyone else in your practice should still be familiar with the general landscape of Medicare standards and the other payers.
Your billing staff should be updated by subscribing to newsletters and attending conferences so that you won’t find your claims denied due to ignorance. Encourage your billing team to share important updates of the software too with the entire practice so that everyone stays up to date.
Complete The Work Upfront
Most claims are denied due to minor mistakes. Train your medical staff to your staff, your providers and everyone else who impacts billing to complete forms accurately, legibly, and without error. By taking care upfront, you minimize agony on the back end.
Train Your Staff
In the majority of the medical billing departments, what doesn’t get checked doesn’t get done. Therefore, it’s best to set your policies in stone up-front and have a daily management system in place which makes sure you have maximum reimbursement and minimize denials.
Set up policies and procedures to make sure that your team is carefully checking reimbursement requests before they are sent to payers. Track the claim denial rate, and set increasingly challenging goals to improve performance over time. A little bit of management goes a long way in minimizing claim denials.
Work On The Daily Denial Claims
Sometimes billing teams are so focused on daily new claims that they fail to re-work or overlook to do a follow-up on the denied claims. No matter what, make it standard procedure for your team to work on denied claims every single day. Just because a claim was denied once does not mean it will be permanently denied. Your billers should be able to make the necessary adjustments and capture the reimbursement with attention and perseverance.
Make Sure That Your Staff Doesn’t Miss The Deadlines
With all the difficulty in the billing segment, denials are inevitable. But there is one type that is inexcusable, and that is a denial based on a failure to file in time. There is no recourse if you miss a deadline, and therefore the money is forever lost. Train your team and reinforce the rule that no claim should ever be late. You should have a 0% rate of denial based on late filing.
Bottom Line For Medical Billing
In every medical practice, maximizing reimbursement equals maximizing revenue (ROI). Without effective billing practices and consistent attention to detail, your practice will experience a high rate of claim denials for all sorts of reasons. A well-managed medical billing team can help you single-handedly increase ROI significantly simply by avoiding and managing claim denials.