Were you aware of the fact that claim denials and rejections are often used interchangeably by healthcare billing companies? How do they manage these during lockdown periods so as not to lose money on a potentially costly mistake?
I can’t say I’m surprised when it comes down from an insurance company side, but there’s no way this is happening without some kind of error right?
The medical billing services/companies will check for errors while submitting their claims all the time in hopes those could sometimes lead them straight into success with payouts owed back if everything goes according plan- well at least up until now anyways! It seems like one little typo or something more significant might ruin everything.
If your medical practice is submitting 10% of the claims it sends out for review, you’re likely to receive a denials letter from an insurer or payer. The reason?
Complex processes like documentation and coding are difficult even in well-prepared offices–and when different rules apply depending on who’s paying provider fees (e.g., insurance companies versus government programs), things can get really confusing fast!
Medical Group Management Association (MGMA) has reported that even the best performing medical practices have 4% of their claims denied. MGMA estimates that 65-percent of all denials are never re-submitted, thus costing about $25 per rejection!
Taking these 5 actionable steps will help you reduce the claim rejections and denials in your medical billing companies.
7 Tips for Reducing Claim Denials and Rejections
Practicing the following tips will surely prevent claim rejections and help out the medical billing services to come up with productive results:
- Complete and Accurate Patient Information
If you’re looking for a quick way to keep your review process moving smoothly, use claim scrubbing software. It has hundreds of built-in filters and will automatically fix common data entry errors like misspellings or wrong genders so that no matter what kind of mistake is made on a patient record it can be corrected before they reach our team!
Usually the mistakes are made when entering date of accident, date of onset, date of medical emergency. So, double check all the entered information. Make sure the information is accurate and complete.
A great way to improve data accuracy and build a better team environment is by issuing “report cards” for your staff. You can provide feedback in order to help them get the most out of their work, without having any major issues that will require appeal or redetermination.
2. Learn from Previous Rejections
It is important to ensure that the proper data has been established when processing claims. This will reduce rejection cases in future and increase revenue flow for insurance companies, but it’s also crucial because being well-organized can help you learn about common denials or rejections where your problem occurred so that they don’t happen again!
When you keep track of the patterns and trends in previous rejections and denials, you can minimize the chances of repeating these mistakes and this results in reduced claim rejections and denials.
3. Get Medical Billing and Coding Experts Involved
Medical billing and coding is a mandatory service for any medical office. Billing can help resolve denials, rejections or other problems with claims by making sure they are coded correctly- this will keep revenue moving smoothly through the cycle! Professional services ensure optimal claim management so you’re always protected in case anything goes wrong along the way
As an added bonus: if low levels of rejection happen often then healthcare providers might experience higher profits as their business has less risk involved since there won’t be any loss due to bad data inputting from yours end.
4. Be Aware About Pandemic-Related Billing Changes
Many providers (medical billing services and companies) have been struggling with COVID-19 pandemic reimbursement changes. Telehealth and telephone visits were a major issue, particularly when it comes to using CPT code 99072 for added safety measures like PPEs which many commercial payers haven’t implemented yet or only partially so they cannot process such claims at all; therefore MGMA suggests putting rejected ones on hold while monitoring if your insurer might be ready any time soon
As your practice reviews the guidelines and code changes from January 1st, you should be on top of any updates that may affect in-clinic services. The Association also suggests reviewing additional E/M service codes (Codes 99202 -99215).
5. Get Help from Clearing House
The clearing house is a partner in the claim filing process. They help you with insurance companies and explain rejection causes clearly, which becomes constant working together with them. Maintain an authentic relationship by building strong contacts that will nurture both groups’ processes while also benefiting themselves- it’s important for everyone’s sake!
Working with the Clearing House is a constant process of helping you understand your insurance company and how they operate. The output tone should be friendly but professional, reflecting their status as an essential partner in this process.
6. Ensure Timely Submission of Claims
If you want your claims to be processed quickly and accurately, it is important that they are submitted by the deadline. If a payer’s guidelines indicate submitting within their specified time frame will ensure eligibility for payment of services rendered or compensation due on an insurance claim (either commercial or Medicare), then make sure this happens.
Your staff should also always keep track when each individual may have access with cheat sheets so there aren’t any missed deadlines in regards to submitting these documents before expiration days which could result into denial as well.
7. Keep A Follow Up on Claims
A quick scan through your submitted claims will show you that the most important ones are being followed up on. It may be hard to keep track of every single one, but it is possible with a little effort and diligence from yourself.
Denial or rejection can often times result in finding what went wrong where so as not have any more missed revenue because these things don’t happen when there’s regular follow-up (and if they do then something has gone seriously wrong).
The above actionable tips will keep your medical billing services safe from claim rejections and denials. Always be updated, organized and attentive while submitting claims in order to reduce rejections. Leave your comments below that how you found this information. We will be happy to have your feedback.