How to Prevent Medical Billing Claim Denials?

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How to Prevent Medical Billing Claim Denials?

• www.mgsionline.com

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• While ensuring efficient patient care, Providers
  and healthcare practices work 24/7 to improve
  their billing performance and revenue.
• However, the introduction of new medical reforms
  in the US healthcare industry have complicated
  their goals.
• New coding techniques and insufficient training
  contributed to more claim denials.
• It is estimated by the Medical Group Management
  Association (MGMA) that even the exceptionally
  performing medical practices end up with 4 claim
  denials.

• Then imagine the claim denial rate of developing
  healthcare practices.
• It is also estimated that almost 65 of claim
  denials are never corrected and refiled.
• Even if healthcare practices take initiative and
  correct the denied claims, they dont submit
  before the time frame of 90 days.
• All these factors affected many healthcare
  practices revenue cycle badly.
• In this article lets see how we can prevent
  medical billing claim denials and improve cash
  flow through efficient denial management

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Analyze and Determine the Cause

• Avoiding claim denials involves a series of steps
  and the first one is to analyze and determine
  what causes claim denials in the first place.
• Right from the frond-end to back-end services,
  there are several operations, which if not
  carried out properly can resort to claim denials.
  They are as follows,

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01
Patient Registration

• This is the very first step when a patient visits
  a healthcare practice and if it is not shown
  proper care, then there can be a huge amount of
  claim denials.
• Front-office staff should make sure that they
  register the patient details accurately while
  verifying their insurance benefits and
  eligibility.

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Coding

• Accuracy in diagnosis and procedure codes is
  crucial to proper denial management. Carrying out
  the wrong diagnosis or coding incorrectly can
  result in a lot of claim denials.
• It is for this purpose that healthcare practices
  should offer enough training to their staff to
  carry out unsurpassed medical billing functions
  as per the new coding techniques.

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Billing

• Sometimes, staff submit duplicate claims meaning
  they file a claim for a service more than once.
• Such internal mistakes are perfectly avoidable
  and the denial management team should check twice
  before the claims are filed.

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Filing

• Claims have a certain time limit before which
  they have to be filed.
• The time limit varies from payer to payer.
• Insurance companies will deny the claims simply
  if they are filed beyond this time limit.

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Payer

• After analyzing all the factors, if there are no
  mistakes from the Providers end, then the denial
  management team must look into the Payer.
• Sometimes, payers make errors while processing
  the claims.
• If so, then call the respective insurance company
  and address the issue.

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Prioritize

• Once Providers fix the root cause of their claim
  denials, they should set up a good denial
  management team.
• The team will further analyze which factors cause
  the highest impact and prioritize.
• The causes are then eradicated one by one in the
  order of the prioritization

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07
Claims Management Software

• Yet another important step in managing claim
  denials is setting up a proper claims management
  software in to your system.
• The denial management team should use data
  analytics and study the pattern of claim denials
  to optimize the software and offer great
  solutions.
• This enables healthcare practices avoid claim
  denials in the future.

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About MGSI

• All the aforementioned steps can be done
  proficiently by a reputed medical billing
  company. 
• Therefore, partnering with one will save ample
  costs for healthcare practices.
• If you are looking for a highly-experienced
  organization then look no further than MGSI, a
  one-stop-shop to all your medical billing needs.
• This Florida-based company has more than 20 years
  of experience providing exceptional denial
  management services to its clients.
• To learn more details, log on to www.mgsionline.co
  m.

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