5 ways in which medical claim denials can be avoided
One of the greatest challenges of medical billing process is avoiding claim denials as they can adversely affect the cash flow of a healthcare business as well as their relationship with the patient.
Medical claim denials are the ones that the payer has received, processed and marked as unpayable.
In medical practices, the range of medical billing denials usually lies between 5-10%.
The most common reasons leading to claim denials include inability to provide required pre-authorization, missing documentation, claim form errors in patient data or procedure codes, duplicate claim submission, claim submission after the deadline issued by the payer, medical procedure not considered as a necessity, ineligibility due to lack of coverage by the payer and use of out-of-network provider etc.
Some pragmatic ways that a competent medical billing and coding company can employ to avoid claim denials are discussed below:
Efficient information collection process
For the medical claims to go through in a smooth manner, it is imperative that the information collection should be conducted efficiently. A minor mistake in data entry such as a misspelled name or incorrect gender can cause denial. In this regard, a representative of the medical billing company should work in close liaison with the front desk of the medical facility where the information of the patient as well as the insurance company/payer is being submitted. Potential errors should be eradicated at the grassroots. Patient eligibility should be verified, the insurance information of regular patients should be updated and the correct insurance option should be selected.
Thorough proofreading before submission of claims
Efficient collection process, while necessary is not enough. Consistent checking and verification should take place in order to avoid mistakes and proofreading at the final stage of the process, that is, right before submission is crucial. To avoid the smallest of errors that can result in the denial of a claim, claims should be revised and edited thoroughly before submission. Proofreading can easily resolve minor issues leading to claim denial. In this regard, the most common factors leading to claim denials should be kept in mind such as omission or expiry of pre-authorization codes, errors as well as slips in documentation or verification, eligibility and coverage related issues, contractual issues, coding and filing errors, deadlines, cash posting errors, submission and rebilling problems etc.
Optimal use of technology
While the training of the medical billing and coding staff is of utmost importance, it is equally important to integrate technology and automate some procedures to avoid any chance of human error. Paper forms require manual review but electronic forms can be submitted into the adjudication system thus reducing the time invested in data entry and also eliminating any chance of data entry mistakes. All accounting functions can be automatically tracked and integrated with the use of technology. Use of software to assign codes to treatments and diseases has many special features which would be cumbersome if done manually. Technology should be employed for maintaining the privacy and security of medical data. Use of technology in medical billing and coding process facilitates multiple functions from generating invoices to tracking payments, cutting medical expenses, applying Medicare rules to claims and recognizing saving opportunities.
Staying abreast with updated insurance requirements
Insurance carriers regularly update insurance requirements such as the time period of settlement of claims, necessary documentation, coverage etc. and the medical billing and coding company needs to stay up-to-date with the updated information and procedures in order to avoid claim rejection or denials.
Analysis of previously occurred claim denials
Making a study of the previous claim denials in order to understand one’s mistakes and rectifying them to avoid a similar recurrence is a useful way to avoid claim denials. Previous claim denials and rejections should be observed and the trends in denials should be tracked, categorized and analyzed so that remedies to dodge these denials can be contrived.
This was a glimpse of the few strategies that we employ at Avernus Medical Billing to avoid denials for healthcare facilities that have hired our billing and coding services.
As a medical billing and coding company working towards organizing, managing and maintaining your billed services and accounts receivables in an effective manner, we will not only help your healthcare facility reduce the rate of your claim denials but will be your greatest aide in financial growth and success in the industry.
Wouldn’t you want to hire our expert service to ensure that your work is billed and charged, minimizing the risk of losing income and federal non-compliance?
Call us at at +1 817-989-6949 or send us a mail at info@avernuscorp.com and we will be delighted to assist you.