11 Apr Claim Denials: The Elephant in the Accounting Room
As if creating an insurance claim isn’t time-consuming and complicated enough, if that claim is denied it will require more staff time to analyze the reason for the denial, fix incorrect information, find and add any missing information, and then resubmit the claim. All of which means more cost to the practice, more stress-filled time for staff, and less time available for patients.
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Denied insurance claims are one of the biggest hazards to the health of a practice’s bottom line, as well as to the well-being of staff and patient satisfaction. Yet denied claims and their impact continue to be a subject most practices would like to pretend doesn’t exist:
- 30% of claims are either denied, lost or ignored
- 65% of all claims are never reworked
- Denials represent 90% of missed revenue opportunities
If any of these statistics are a snapshot of what’s happening in your practice, it might be a good time to face some other numbers — the cost of denied claims:
- The average cost to file an initial claim is $6.50
- A rejected claim will cost another $25 to resubmit
- Total cost for a single denied claim is $31.50
The number of denied claims your practice is fielding every month, multiplied by $31.50 and then by 12, represents the amount of money being lost annually.
Denial Management: NOT Simple
If creating clean claims was easy, everyone would do it. But there are so many reasons a claim can be denied:
- Missing information
- Service not covered by Payer
- Duplicate claim or service
- Claim not filed on time
- Wrong demographic information
- Incorrect provider information
- Wrong CPT codes
In order to make sure clean claims are generated, here’s what has to happen:
- Staff stays updated on coding rules
- The office uses advanced medical billing software
- All insurance benefits are verified
- All patient information is verified
- All information is carefully reviewed before submitting a claim
The Clean Claim: Billing Nirvana
A clean claim means a medical claim that was never rejected, did not have preventable denial, was not filed more than once, and had no errors. By this time it should be apparent that accomplishing this is no easy feat, especially on a consistent basis.
Medusind: The Professional Solution
Creating a clean claim requires the expertise of professionals who are as skilled at their job as any provider. Every member of Medusind’s Claims team is well-versed in the requirements of a clean claim, always current in the latest codes, regulations, and the necessary attachments. It’s knowledge that helps avoid the denials that directly impact a practice’s bottom line. Medusind claims professionals are also available whenever they’re needed, on the phone or in person, not via chat or an 800#, to answer questions and solve issues.
If it’s time for clean claims to be a consistent part of your practice and a plus for your bottom line, it’s time to call Medusind.