The ongoing pandemic has caused arguably the worst financial strain, the US healthcare system has ever experienced. Healthcare providers are facing immense challenges to keep their claims process optimized. Therefore, they are looking for innovative solutions to reduce claim denials.

No doubt, the denial of a patient’s insurance claims is a major headache for medical practitioners. Because it negatively impacts the revenue cycle management of your medical practice. Therefore, you should strive to generate optimized cash flow to survive in the fast-pacing healthcare industry.

Healthcare providers should implement proper management for medical billing services to get properly reimbursed for services provided. Clean claims submission is an essential component of efficient medical billing services.

However, with the increasing emphasis on value-based documentation and strict processing guidelines established by regulatory bodies, it has become extremely challenging for medical practitioners to reduce claim denials. However, by adopting the right strategies you can overcome these problems to achieve your financial goals. 

Common Reasons for Claim Denials?

It’s a reality that some physicians are still using orthodox methods to process and submit medical claims. These methods are manual and inefficient – involving calls to payers, costly claim resubmissions, and long wait times for reimbursements.

The traditional techniques to handle medical claims always leave room for mistakes.  Before taking further actions to prevent the claim denials, it’s very important to identify the reasons behind this issue. The most common reasons for claim denials are:

Missing/incorrect patient’s information

Medical claims containing incorrect patient’s demographic information including name, date of birth, phone number, Insurance ID, or policy, are rejected or denied.

Outdated Insurance Information

It is extremely important to update the patient’s data timely. Because it is possible that your patients have switched insurance policies and didn’t inform you.

As a result, you send the claim to the wrong insurance company or mention the wrong policy on medical claims. Such claims get denied. Therefore, you should ask your patients to bring insurance cards at every visit. The other issues related to insurance may include:

  • Lack of medical necessity
  • No referral/authorization
  • No supporting documentation
  • Payer requires additional information from the patient
  • Provider not permitted to see the patient under the plan
  • Service not covered
  • The wrong insurance billed

Late submission of claims

Insurance companies don’t accept claims which are not submitted before the due date.

How to Reduce Claim Denials?

Is your medical practice struggling with a high rate of claim denials? If yes then it’s an indicating sign that you should take immediate action to prevent the claim denials. Here are the following tips that can help you to streamline the cash flow of your medical practice by lowering the denial rate.

Improve Data Quality

It is the first and foremost responsibility of your front desk staff to ensure the accuracy of the patients’ data including personal as well as insurance information.

Because, simple errors, such as the wrong spellings of a patient’s name or any missing information can lead to claim denials. Which slows down the reimbursements.

Moreover, your registration staff should verify the patients’  insurance eligibility before scheduling an appointment or providing healthcare services. It reduces the chances of the claim denials due to such reasons.

Your staff must stay connected with the insurance companies to verify the insurance coverage plan of the patients. So, in order to streamline the information flow throughout the healthcare revenue cycle management, you should pay special attention to the training of your registration staff.

Because it doesn’t matter how many automated eligibility or verification tools are available. Your staff must know the use of such tools.

Stay Current With Industry Changes

The healthcare industry is witnessing constant evolutions. Therefore, it becomes essential for medical practitioners and billers to undergo constant training to stay on top of the changes.

Constant training is also important because there are several codes that are modified and introduced each year. If you file a claim with outdated medical claims, then it gets denied.

So, it is crucial for healthcare providers to keep themselves as well as their billing teams updated with the ongoing changes in federal laws, insurance policies, medical coding, and billing guidelines. Because it is important to prepare medical claims as per industry standards.

Effective claims management

Time is the most important component of streamlined revenue cycle management.  Every payer has different deadlines to file medical claims.  If you miss a deadline, the claim will usually be denied. Therefore, it is the primary responsibility of medical billers to file error-free claims in a timely manner.

Moreover, medical practitioners must establish a process that ensures that all claims are submitted (even if electronically) have indeed been received by the payer. If you want to increase the efficiency of the claims process, then replace the paper claims with electronic solutions.

Because electronic claims submission reduces the excessive burden and obviously accuracy as compared to manual submission.  Electronic billing solutions help you to reduce claim denials and streamline the cash flow of your medical practice.

In addition to this, medical billers must have access to advanced software to track and monitor each and every claim through the billing process. In this way, you become able to identify the issues and find a suitable solution to reduce the claim denials.

Outsource Medical Billing Services

If you are facing challenges to keep a balance between your administrative tasks and patients’ care, then hiring a medical billing agency is the best solution to keep your revenue cycle management optimized.

Outsourced medical billing experts eliminate the excessive burden of healthcare providers and enable them to concentrate on the patients’ care. They have in-depth industry knowledge to manage medical billing services efficiently. As a result, healthcare providers enjoy a healthy bottom-line.

MedicalBillingBenefits is an industry-leading healthcare news wire that has been providing the latest information about the new or modified trends in the fields of medical billing and the overall healthcare industry. Subscribe to our Enewsletter to know more about the proactive ways to reduce claim denials.