Doctors, whose raison d’etre is to heal, actually end up focusing on loopholes in their billing process than focusing on tending the patients. Healing their patients and working towards healing the shortcomings of their billing process, resulting into denials is more of a balancing act. Most often there is a question as to why bills get denied where most commonly careless mistakes which are to be blamed.
It is true that there are times when it becomes difficult to understand the patients’ handwriting or one might not understand the notes of the doctor which leads to claims getting denied. Add to that the typos and missing information which can pile on the misery.
A denied claim cramps up the reimbursement process and if it is not detected in time it moves on to the Accounts Receivables team which is not really where one wants the claim to go.
One needs to understand that even though one might have the most effective medical billing software; medical practices have to still face some level of denials. As per the American Academy of Family Physicians, the average denial rate for providers oscillates between 5 and 10 percent. However, the goal is to keep the denial rate below 5 percent, as a lower denial rate means more cash inflow.
Reducing Claims Denial
Providers may keep on blaming the payers for denying their claims but it would be prudent to keep a check on one’s own process and make the required changes so as to reduce denials and increase profits.
Honing Coding Practices
Being as specific as possible is of utmost importance in medical coding. Be it symptoms, services, diseases each one should be coded to the highest possible level. If the insurance carrier finds that the claim is not precise enough they will deny the claim. The good thing about the advent of ICD – 10 is that now the codes are more specific as seven alpha–numeric codes are applied in comparison to the three or four in ICD – 9. This means that variables such as the type of encounter that prompted the visit which led to the relief or non – relief of symptoms will also be documented.
However, many feel that in the initial stages of ICD–10 there will be an increase in denial rates especially for practices that were not prepared for the transition.
As manual processes play a huge role in denials it makes sense in automating the process. Electronic billing has the potency to increase the accuracy of the claims which will help in lesser denials.
Double Checking Before Submission
As a thumb rule practice should make it a point to check their claims before submitting. Many a time simple mistakes made during coding could result in the denial of the claim. Hence, correcting the claims before the submission is vital. However, to do it manually would be time-consuming so it would make sense to do it with the help of billing software.