How much do medical practices pay to manage the average denial

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How much Do Medical Practices Pay to Manage the Average Denial?

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Denied claims can be quite exasperating for billers as well as providers. Not only valuable time gets consumed in claim re-submission but it also costs money to manage an average denial. This means, a significant amount for rendered services is already lost even if the billing department manages to collect payment through re-submission.

If your denial rate is more than 5%, it means you are not paying attention to your revenue cycle. It can result in major erosion of revenues, forcing you to close down or merge your practice with a hospital.

Industry Facts :

According to the Medical Group Management Association, approximately $25 to $30 gets spent on managing an average denial Nearly 30% from the total filed claims gets denied due to minor errors in coding and technical aspects As per the research done by American Medical Association (AMA), there was a sharp increase in claim denial rates in 2012; however, in 2013, claim denial rates reduced by 47% Medicare happens to have the high denial rate at 4.92% while lowest denial rate is of Cigna at 54% www.medicalbillersandcoders.com Copyright Š-2013 MBC. All Rights Reserved.

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As per an estimate by the CMS, there are chances of claim denial rates increasing by 100% to 200% in the early stages of ICD-10 coding What causes claim denials?

There are various reasons due to which payers reject medical claims: 

Lack of accuracy in registration, wherein a wrong payer is mentioned, patient's insurance is not verified or it becomes difficult to decipher the identity of a patient



Charge entry is done with unacceptable diagnosis codes or procedure codes

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Inadequate information about a patient

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No substantial proof to prove medical necessity of a procedure

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Lack of pre-authorizations and referrals



Errors in clinical documentation

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Lack of credentialing www.medicalbillersandcoders.com Copyright ©-2013 MBC. All Rights Reserved.

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Submission of claims with duplicate codes for same procedures



Bundling non-allowable items or applying modifiers where they aren't applicable

How to reduce occurrence of denied claims? 

Identifying the type of denial because denials can be clinical as well as technical



Training staff on how to submit error-free claims, edit claims and prepare appeals

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Formation of a strong billing team with certified, experienced coders and billers

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Monitoring the progress made by in-house or billing company's team on a regular basis

Most medical practices are overloaded with work due to which they have very little time to fulfill the above-mentioned requirements. Since denial management is a daunting task, they prefer outsourcing billing and coding services to a billing company that has proven capabilities of providing effective denial management.

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Call now 888-357-3226 (Toll Free) http://www.medicalbillersandcoders.com End to End Medical Billing Solutions

Tackling claim denial with MBC: MBC has the largest consortium of certified coders and billers, helping practices maximize revenue and minimize claim denials. The team at MBC is well-trained in error-free claim submission, follow-ups with insurance companies and effective denial management. MBC also specializes in: 

Analysis of financial impact of denials

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Finding causes for accumulation of denied claims

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Providing feedback through financial impact analysis of denials and root-cause analysis

MBC helps practices maximize and accelerate their cash flow through:

Charge entry analysis + Tracking payer denials +

Tracking claim status

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