Claim denial is a common occurrence in medical billing, which causes major headaches for medical practitioners. The denial of a patient’s insurance claim negatively impacts your revenue. It also increases workflow and can cost you significant rework.
Therefore, submitting clean claims should be a top priority for your medical practice.
Today, we take a comprehensive look at six ways to reduce denials in medical billing. Although documentation, billing, and coding are not simple, you can always take proactive steps to reduce your denial rate.
Read on to adopt the right strategies to help you overcome these issues and safeguard your bottom line.
Identify Major Causes for High Medical Billing Denial Rates
Has there been a recent increase in the number of claims denials? It will help to start by identifying the possible reasons behind the rise. The reasons will vary by specialty and practice.
Start by compiling the reason codes for claim adjustments. You can build a suitable denial management strategy for your practice from there. Although the codes may be cryptic and inconsistent, you can use them to map descriptors.
Some of the most common reasons for high claim denial rates include the following:
- Duplicity of claim
- Outdated insurance information
- Expired eligibility
- The invalidity of a diagnosis or procedure
- Incorrect patient information
- Lack of referral or medical authorization
- Inaccurate insurer address
- Lack of sufficient documentation
- Demographic errors
- Late claims submission
Improve Quality of Collected Data
The front desk staff is responsible for collecting accurate patient data. Patient data should include the patient’s personal and insurance information. A simple error such as misspelling a patient’s name can lead to claim denials.
Your registration staff should also verify the insurance eligibility of every patient before scheduling an appointment. Ensure each patient’s policy is still active and confirm patients’ coverage plans before each appointment. Completing eligibility before patients’ appointments helps reduce the chances of claim denials within your healthcare facility.
Emphasize proper training of your registration staff to improve data quality. Improving the quality of your data helps streamline the flow of information within your revenue cycle.
Stay Updated with Industry Changes for Medical Billing
The healthcare industry and ICD 10 coding guidelines experience constant updates. Therefore, medical practitioners should undergo continual training. Keeping your staff up-to-date can help your practice stay compliant. Frequent changes include insurance policies, federal laws, billing guidelines, and medical coding.
Equally, the federal government introduces and modifies several codes every year. Any outdated medical claims with old codes will be denied immediately. Keeping on top of changes within your industry will significantly decrease your practice’s denial rate.
Effective Claims Management
A streamlined revenue cycle management process depends on one critical component: time. Every person has to meet a specific deadline when filing medical claims. Therefore, medical billers have to file error-free claims on time.
As a medical practitioner, you are responsible for establishing processes that verify timely submissions of all claims. One way to increase efficiency is by going paperless. Electronic solutions help increase accuracy while reducing the excessive burden of paper claims.
Ensure you integrate advanced software into your practice to help monitor and track every claim within your billing process. By doing so, you can identify any issues that might lead to claim denial, which leads to easier-to-find, suitable solutions when reworking claim denials.
Resolve Issues Early
Resolve all issues before filing a claim. Ensure the billing staff sits down with patients to try and sort out any problems detected in the first stages. Be sure your employees find an amicable solution while staying transparent with your patients.
Problems with a patient’s insurance can always lead to frustration. It exposes your brand to negative reviews – impacting your brand loyalty, even if your practice is not the root cause. Always ensure your employees handle troubling findings with care and understanding.
Minimizing medical billing costs ultimately comes down to staying in front of any arising problems. It also ensures you can fix any issues promptly, thus ensuring no hold-ups in payment.
Hire a Medical Billing Agency to Help Reduce Denials
Balancing patient care and administrative tasks is a massive challenge for any size practice. Outsourcing your medical billing services is an excellent solution to reducing denials. With outsourcing, you can optimize your revenue cycle management without compromising the quality of care.
Hiring a medical billing agency ensures healthcare providers can focus on what matters most: providing excellent patient care. A third-party medical billing partner can leverage its in-depth industry expertise to provide efficient medical billing services—allowing your medical practice to benefit from increased cash flow and reduced claim denials. CBS Medical Billing and Consulting is your practice’s missing piece.
We are an industry-leading medical billing and revenue management company that can help you reduce claims denial. Ensure you contact us today to learn more about how our medical billing services can aid in decreasing claim denial rates.
