How to Reduce Eligibility Rejections and Denials

For most providers, eligibility rejections and denials are the number one reason for payment delays and labor overruns.  Knowing how to reduce eligibility rejections and denials is an important first step to enact cost saving measures at your practice.

A survey cited by Becker’s Hospital CFO Report agreed with findings that almost 24% of all denials are due to eligibility. The cost of correcting claims is steep. The American Medical Association recently published an article in JAMA that priced insurance follow-up for registration issues at a little under $19 per claim. This means practices that reduce their eligibility denial count by 5 per day can save almost $100 per day in administrative costs.

The best way to prevent eligibility rejections and denials is to practice proactive front desk management to stop them from happening in the first place. A few simple workflow changes are all it takes to affect the accuracy of your claims.

Educate all staff about the revenue cycle

Making sure the practice is paid for the work it does is everyone’s responsibility. However, some front desk personnel can operate under the assumption that denied claims have nothing to do with them. Educate front desk staff about the claims process, so they understand that incorrect information leads to denied claims – and that denied claims lead to disgruntled patients, more work and potentially less revenue for everyone’s paycheck.

Share denial statistics

Consider making denials an ongoing topic of discussion during team meetings. Share claim rejection and denial rates and set goals for improvement. If staff is making a concerted effort to increase accuracy, the results will be apparent in a short amount of time – usually within a month or two.

Hold front desk staff accountable for registration errors

If your practice has a paper registration process, it is critically important to confirm all demographic and insurance information against the patient ID and insurance card. Some offices choose to scan IDs and cards for later reference. However, scans should not negate responsibility for obtaining correct information. We suggest having front desk personnel initial every page of the registration packet to verify it has been checked for completeness and accuracy.

Confirm address and insurance information at every visit

People move to a new house and switch jobs regularly. Two simple questions can make a big difference:

· Are you still on XXXX street?

· Are you still with XXXX insurance?

A quick confirmation of information with established patients can dramatically decrease denials. Specialties such as allergy and psychiatry, which see patients often, must ask these questions every time because once a claim is denied, there could be several claims in adjudication that will soon be denied as well. A denial domino-effect can quickly develop.

Use technology whenever possible

Thoroughly audit how insurance is verified. Scrutinize when phone calls are required because they are the most expensive and time-consuming of all the ways to check coverage. Many free benefit look-up tools get the job done, but consider using one system, like MedClarity, that can meet all your needs. The time saved switching from one system to another may may then be re-purposed for more impactful tasks. Another advantage of using technology is running batch checks and having the option to automate when checks are performed.

Knowing how to reduce eligibility rejections and denials boils down to attention to detail

The saying, “garbage in, garbage out,” 100% applies to medical billing. In some circumstances, all it takes to receive a denied claim is a missing middle initial or forgetting to add a suffix to a name such as “Sr” or “III.” Names, numbers and other identifying information need to be submitted onto claims exactly as they appear on the insurance card. Attention to detail at the front desk is one of the most essential attributes to look for when hiring front desk staff.

In general, the front desk is not always seen as a mission critical position. The truth, though, is that the front desk is a pivotal position in the office. They are the first to greet patients, collect balances owed to the organization, confirm all required patient information is complete and correct, and must know how to reduce eligibility rejections and denials. Organizations that acknowledge the importance of an experienced and efficient front desk employee will be best positioned to reap the rewards of cleaner claims and decreased denials.

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