5 Best Practices to Reduce Claim Denials

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5 Best Practices to Reduce Claim Denials
Medical practices of all sizes dont pay
attention to claims that get denied. Most of them
just believe in submitting the claims, start
expecting insurance reimbursements. There is no
claim tracking, no claim follows up involve.
After a few months, they will start realizing
they are working more and earning less. Claim
denials are the obvious reason for reducing
insurance reimbursements. When you submit a
claim, the payer can either pay it or deny the
payment with a suitable denial reason. Provider
or billing staff need to study these denial
reasons and resubmit the claim with changes or
additional information. Common claim denial
reasons include missing or incorrect data
patient eligibility lack of medical necessity
duplicate claim submission lack of
documentation non-payable diagnosis codes lack
of prior authorizations and wrong procedure
codes. You can easily figure out that most of the
common claim denials are easily avoidable. So, in
this article, we have discussed 5 best practices
to reduce claim denials. You will be surprised to
know that about two-thirds of all denied claims
are recoverable, even then also only 35 of them
are resubmitted. 5 Best Practices to Reduce
Claim Denials 1. Track all your claims
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5 Best Practices to Reduce Claim Denials
Just submitting claims is not enough, monitoring
and documenting each of your practices claims
and denials is crucial. It enables you to ensure
claims are submitted and appealed in a timely
manner, spot trends in denials, and maintain
detailed oversight of the portion of the claims
of your revenue cycle. Each patient encounter
ideally should be coded on the date of service.
Denied claims should be tracked by type and payer
when posting payments or at other regular
intervals. 2. Identify common claim denial
reasons Routinely run a detailed report of your
practices denied claims. Though the reason(s)
for denial typically varies by specialty and
practice, this report allows you to more easily
pinpoint specific claims without having to sift
through multiple ones. Also consider maintaining
a log listing your denials, including the type of
denial, the date it was received, and the date
you appealed it. If you notice a problematic
trend through this documentation, address it
immediately to avoid additional claim denials.
After gathering denied claim data, if you focus
on top 3 denial reasons you will be recovering
more than 80 percent of your lost
reimbursements. 3. Track your denial rate
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5 Best Practices to Reduce Claim Denials
Knowing the denial rate of your practice lets you
target areas that are especially troublesome for
your revenue cycle. We suggest the following
method to calculate your practices denial rate
add the total dollar amount of claims denied by
payers within a given period and divide by the
total dollar amount of claims submitted within
the given period. If possible, your rate should
also be computed by payer, provider, and reason
for denial. 4. Provide constant training for
your staff Knowledge of complex and changing
documentation requirements (i.e., ICD-10) and
accurate data entry are key for billing staff to
correctly and expediently handling the claims
process. Ensure you have adequate staffing to
process claims and communicate regularly with
your team members about policies and procedures
that affect denied claims. Emphasize regular
training to keep employees updated on the new or
updated procedure and diagnostic codes, appeals
processes, and instructions particular to each
payer. 5. Check insurance coverage for every
visit The eligibility and benefits verification
process ensures that you will receive all the
reimbursement you deserve.
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5 Best Practices to Reduce Claim Denials
It will help you to understand if the patient has
active coverage or not what services are
included what is patient responsibility is
there any need for prior authorization and many
others. Eligibility check before every patient
visit will ensure that you will have all the
correct information to fill the claim, which
makes fewer chances of the claim getting denied.
You can simply call the insurance rep and
understand patient coverage payable procedure
codes, and understand the medical
necessity. Above mentioned 5 best practices will
definitely help to reduce claim denials. To
implement these 5 best practices, you will
require the providers time and expert medical
billing staff. As the providers are busy in
patient care and expert medical billers are
difficult to retain, outsourcing your billing
could be a practical solution for denial
management. Medical Billers and Coders
(MBC) provides denial management and resolution
service which includes eligibility verification
clean claim submission claim tracking accounts
receivable (AR) management and reporting. All
these functions are conducted by billing and
coding experts as per your medical specialty. If
you want to know how we can assist you in
reducing claim denials and increasing insurance
reimbursements, contact us at info_at_medicalbillersa
ndcoders.com/ 888-357-3226.