Are you tired of dealing with frequent denied claims that obstruct your practice’s revenue cycle? Denied claims not only slow down your cash flow but also add an unnecessary burden to your administrative workload. As a medical specialist, you understand the importance of maintaining a healthy revenue cycle. In this blog, we’ll explore how, from Day 0 to Day 90, MBC transforms the top 5 RCM denial trends.
Denial Trends in Revenue Cycle Management
Denied claims, also known as claim rejections, occur when insurers refuse to reimburse for billed healthcare services. These rejections stem from various causes, such as coding errors or more intricate issues like medical necessity disputes or failure to meet policy criteria.
The American Medical Association (AMA) reports that initially, 15% of medical claims face denial––posing substantial financial challenges for healthcare providers. Timely resolution of these denials is essential for sustaining financial stability.
Key Reasons for Claim Denials that Impact Revenue Cycle
1. Patient Information:
Errors in patient information can lead to immediate claim denials. Incorrect or incomplete details are common issues that can be easily avoided with meticulous attention to data entry and verification processes.
2. Medical Necessity:
Medical necessity denials occur when the insurer deems a procedure or service not essential. Ensuring proper documentation and justification for every service can significantly reduce these denials.
3. Coding Errors:
Clerical errors in coding are a leading cause of claim denials. Adhering to up-to-date coding standards and continuous education on coding practices can mitigate these errors.
4. Submission Timeline:
Missing submission deadlines can result in automatic denials. Hence, timely submission of claims is crucial.
5. Eligibility:
Verifying patient eligibility before providing services is essential to prevent eligibility-related denials. A robust verification system can ensure coverage and avoid unexpected denials.
How MBC Revolutionizes Your Revenue Cycle in 90 Days?
From Day 0 to Day 90, Medical Billers and Coders (MBC) can transform your practice by addressing the top five denial trends in revenue cycle management. Let’s delve into how MBC’s strategic approach can turn your denial trends into revenue streams.
Day 0: Identifying the Issues
On Day 0, your practice might face high denial rates due to:
- Patient Information Errors: Incomplete or incorrect patient information can lead to immediate denials.
- Medical Necessity: Claims lacking sufficient medical necessity documentation are often rejected.
- Coding Errors: Mistakes in medical coding, whether due to outdated systems or human error, are common.
- Submission Timeline: Late submissions can result in automatic denials.
- Eligibility Issues: Claims submitted without verifying patient eligibility are likely to be denied.
Day 45: Implementing Solutions
By Day 45, MBC’s targeted strategies start showing results. Here’s how:
- Enhanced Patient Information Systems: We ensure all patient data is accurate and up-to-date.
- Medical Necessity Documentation: We help in maintaining detailed documentation and meeting insurance requirements.
- Coding Accuracy: We conduct regular audits and updates to coding practices to minimize errors.
- Timely Submissions: Our streamlined processes ensure claims are submitted within the required timeframe.
- Eligibility Verification: Our pre-claim eligibility checks prevent unnecessary denials.
Day 90: Achieving Results
By Day 90, you will notice significant improvements:
- Reduced Denial Rates: Our interventions have led to a noticeable drop in denial rates.
- Improved Cash Flow: Efficient claim processing ensures faster reimbursements.
- Optimized Revenue Cycle: Your practice’s financial health is significantly better with fewer denied claims.
Ready to turn denials into approvals and boost your revenue?
Contact MBC today and discover how our proven strategies can transform your revenue cycle in just 90 days. Don’t let denials hold your practice back—partner with MBC for sustainable financial growth. Call us at: 888-357-3226 or email us at: info@medicalbillersandcoders.com
FAQs:
1. What are the common reasons for medical claim denials?
Denied claims often result from clerical errors, coding mistakes, lack of medical necessity, and eligibility issues.
2. How can outsourcing medical billing help my practice?
Outsourcing to a specialized service like MBC reduces errors, ensures timely submissions, and frees up your time to focus on patient care.
3. Where can I find trusted sources for medical billing and coding?
A: Trusted sources include the Centers for Medicare & Medicaid Services (CMS), the American Health Information Management Association (AHIMA), and the American Medical Association (AMA).
