Denial Analysis In Medical Billing For Higher Reimbursement

1
Denial Analysis In Medical Billing For Higher
Reimbursement
2
Denial Analysis In Medical Billing For Higher
Reimbursement
To ensure the smooth functioning of operations in
healthcare, there must be no loopholes or hurdles
detected in the revenue cycle of the
organization. The major hurdle for every
healthcare organization or physician is claim
denials from insurance companies. These are the
claims that have been received, processed,
adjudicated by the payer who is generally an
insurance agency and has been deemed as
unpayable. Claims which are denied cannot be
resubmitted without finding the cause of denial.
Payers sent their reasons or conditions upon
which denial was declared so that billing
respondents can send reconsideration requests by
analyzing and resolving those reasons. Though
these denied claims can be sent back again after
rectifications but the whole process of
converting a denied claim into a claim without
issues or as per suggestions takes a lot of time
and effort. Therefore, billing agencies to make
sure to send clean claims in the first attempt to
avoid such a cumbersome process and it is
observed that the following are the main reasons
for claim denials, and you can perform denial
analysis in medical billing for higher
reimbursement.
3
Denial Analysis In Medical Billing For Higher
Reimbursement
Reasons for claim denials Incomplete or improper
coding Lack of full and accurate code or bad and
old coding are the reasons most claims get
denied. Hence you should be aware of the latest
changes in coding. Claim form errors/ Patient
information error These simple errors like
missing information of the patient, treatment
given, or even nominal form errors could be the
cause of denied claims. Especially in
emergencies, this information can take you down
in a panicked moment and cause an issue. Claim
submission after the deadline Due to any internal
reason, if claims are not submitted or filled
within the prescribed deadline of the insurer,
then these insurance agencies stand in full right
to deny claims. Preauthorization Healthcare
providers sometimes ignore this important aspect
of getting a particular service or treatment
authorized by the insurer to avoid any such
circumstances in the future.
4
Denial Analysis In Medical Billing For Higher
Reimbursement
Lack of proper documentation Insurer companies
have their own set of conditions and regulations
and to comply with them, one basic yet important
step is to provide all relevant documentation
about the treatment given and service
provided. Because of the above-mentioned reasons
claims submitted by providers get denied by
payers and therefore denial analysis becomes an
area of vital attention. Denial analysis can
help providers and billing agencies to track
where are the shortcomings in the claim
submission process and by tracking and monitoring
those, you can improve the overall claim denial
process to avoid such problems in the
future. Steps to overcome claim denials These
steps can help overcome claim denials and can
ensure higher reimbursements Training
staff Giving appropriate training to your billing
staff and staff that is responsible for handling
claims can reduce the chances of errors observed
in claim forms and also verify patient
information.
5
Denial Analysis In Medical Billing For Higher
Reimbursement
Robust preauthorization Creating a dedicated team
to work on the authorization process regarding
treatment or service needed by the patient and
ensuring complete clarity on terms and conditions
provided by the insurer can help in avoiding
negative consequences. Trained coding
professionals Well-trained coding experts can
help to avert coding problems, they will ensure
code is as per the latest standard
requirement. Conduct audits and analyses trends
in claim denials Routine audits by tracking
trends or patterns in denied claims, working on
them, and improving them become easier
tasks. Communication Ensure continuous and
transparent communication with the insurer or
payer because that will help in staying updated
as per their conditions and contract
requirements.
6
Denial Analysis In Medical Billing For Higher
Reimbursement
Automated software Effective use of automated
software which helps in claim management by
verifying patient information, treatment, or a
service requirement with insurer conditions and
by performing predictive analysis, denials could
be evaded, and smoother management of denials can
be experienced. If you are struggling with
denied claims and looking for outsourcing your
medical billing then you can trust us. We are
having a team of experienced Billers and Coders
and our clean claim submission rate is above 95.
If you want to perform denial analysis in
medical billing for higher reimbursement then you
can get in touch with us.
7
(No Transcript)