How to Prevent Medical Claim Denials

How to Reduce Claim Denials

Knowing how to reduce claim denials can help your practice avoid the constant headaches of denied claims that negatively affect your practice’s revenue, cash flow, and efficiency

On average almost $15,000 per year is spent on investigating, appealing and reworking denied claims! It can be difficult to know exactly what the payers are thinking with their constantly changing rules and regulations but you can remove some of the guesswork. This quick guide will help you and your practice know how to reduce claim denials like the pros!

The following medical billing mistakes are common causes of claim denials and knowing how to address them will create a positive impact on your medical practice’s bottom line.

Missing a Claim Deadline

With all the complexity in the medical billing landscape, some denials due to human error are inevitable. The one type that is inexcusable, though, is a denial based on a failure to file in time. This is better known as the “timely filing rule.” Practices know that missing this deadline creates a situation where money could be lost forever.

Train your team and reinforce that no claim should ever be late. Start by creating an easy-to-see reminder in your front office to help your staff avoid claims lost due to timely filing. Reminders for individual payers can also b posted or distributed in an easy-to-read document throughout the practice.

If you outsource your billing to a medical billing service they will serve as your partner and be in charge of these deadlines to submit claims well ahead of the required deadline.

Missing Claim Information

The ever increasing amount of data points required for a claim to be accepted by a payer equates to greater potential for information being omitted. Top performing practices are checking their claims, generally with software, to be sure the claims include the patient’s information, diagnosis codes, CPT codes, and anything else need to get the claim processes.

Just because the fields on the claim are populated doesn’t ensure it will be processed by the payer, though. This is another area where having a great medical billing service will help ease the workload on your staff. Practices enjoy the peace of mind they get when they have a trusted partner to validate claims once they are ready for submission.

Clerical Coding or Insurance Verification Issues

Even if most of your payers accept electronic claims, a few still may require manual submissions. This can cause issues if you’re primarily used to submitting electronic claims. Any messy or illegible print claims may become problematic for payers who scan them into their systems upon receipt. Make sure your billers always look over claims and to confirm they’re readable before sending them off. This is especially important for those payers that are more demanding than others. A helpful tip is to group transactions by payers if you need to find out which ones are denying claims more frequently.

Not verifying the correct insurance coverage is one of the more common mistakes that cause claim denials. Insurance information is constantly changing whether it be at the insured level or for the insurer. It is important that the provider verify eligibility each and every time services are provided. This should become second nature for your staff, given the number of times a patient may change insurance providers throughout their visits.

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