Billers & Coders Expertise in Claim Analysis Helps Tackle Escalating Payer Denials!

Healthcare providers now need to be consistent in improving and measuring growth in nearly all areas of their practice. They are being challenged to process increased number of claims in an accurate manner. However, due to annual payment cuts, rise in number of patients, looming ICD-10 conversion, compliance and pressure to improve documentation, they are left with no time to concentrate on claim processing errors that result in major financial losses.

This has led to an increase in demand for certified and well-trained coders and billers who are experienced in claim analysis. Claim denial analysis has become imperative as providers are losing thousands of dollars and precious administrative time; due to the constantly increasing denial rate of insurance payers.

Industry fact states

The aggregate claim denial rate in the first quarter of 2010 was 19%
In 2011, claims processing errors increased by 2%, resulting in unnecessary administrative costs worth $1.5 billion
Annually, the US healthcare system wastes between $600 to $850 billion due to inefficiencies and errors
On an average, mistakes can be found in 5-10% of all claims submitted
According to AMA, approximately $17 billion can be saved annually by eliminating claim errors
Claim denials are likely to increase with the implementation of ICD-10 in 2014; therefore, practices need to buckle up in order to ensure coding errors don’t cause claim denials

How can claim analysis reduce claim denials?

By conducting claim analysis on a monthly or quarterly basis, providers can find out the reason behind denials. It will also present denial patterns per insurer and help in determining if the claim processing errors were made by the physician staff or the insurance company.

Once practices have this information in hand, it will become easy to control internal deficiencies. It will also help prioritize cases worth appealing.

How can medical billers and coders make claim analysis successful?

Medical billers and coders can make use of their knowledge and experience to check for errors and denials in the claims process-

  • They can help determine if denials are being caused due to coding errors, patient ineligibility or medical necessity
  • By implementing the claims analysis process on a timely basis, they can uncover a pattern of denials, notifying the practice to new rules or policies established by an insurer without any warning
  • They can help providers in demonstration of measured improvement by revealing process gaps, streamlining operations and reducing medical loss

With ICD-10 round the corner, need for a well-trained team of coders and billers has doubly increased for providers. has been offering effective services across 50 states and 42 specialities in the US. The job board at MBC provides a unique platform for all medical billers and coders to obtain jobs in several healthcare organizations.

Billers and coders can access our job portal, industry updates and newsletter for knowledge and opportunities. MBC also offers ICD-10 updates and our consultants strive hard to help clients identify issues, offer effective solutions and analyze proposed rules.

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