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Avoiding These 3 Mistakes Can Help Reduce Claim Denials

On average almost $15,000 per year is spent on investigating, appealing and reworking denied claims.


Medical billing claim denials are constant headaches that negatively affect your practice’s revenue, cash flow, and efficiency. With the constantly changing regulations and payer rules, it can be difficult to stay ahead of everything and focus mainly on claim denials. Understanding the following medical billing mistakes will help your practice reduce claim denials, thus creating a substantial 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. But there is one type that is inexcusable, and that is a denial based on a failure to file in time. Missing a deadline creates a situation where money could be lost forever. Above all, train your team and reinforce that no claim should ever be late. Ideally, creating an easy-to-see reminder in your front office will help your staff avoid this common mistake. Reminders for individual payers should be posted or distributed in an easy-to-read document throughout the practice. If you use a third-party medical billing company, they can serve as your partner and be in charge of these deadlines to submit claims well ahead of the required deadline.

Missing claim information

When you’re dealing with a multitude of numbers and codes, there is always the potential for information being omitted. Your billing team has to be proactive to seek out information that needs to be in a claim before it gets submitted. However, such a review demands a lot of extra time. This is another area where having a medical billing service will help ease the workload from your staff. At the very least they can serve as a backup and check 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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posted by OBarros
posted in Healthcare Management
posted date May 2018