How to Prevent Medical Billing Claim Denials? www.mgsionline.com
While ensuring efficient patient care, Providers and healthcare practices work 24/7 to improve their billing performance and revenue. However, the introduction of new medical reforms in the US healthcare industry have complicated their goals. New coding techniques and insufficient training contributed to more claim denials. It is estimated by the Medical Group Management Association (MGMA) that even the exceptionally performing medical practices end up with 4% claim denials. Then imagine the claim denial rate of developing healthcare practices. It is also estimated that almost 65% of claim denials are never corrected and refiled. Even if healthcare practices take initiative and correct the denied claims, they don’t submit before the time frame of 90 days. All these factors affected many healthcare practices’ revenue cycle badly. In this article let’s see how we can prevent medical billing claim denials and improve cash flow through efficient denial management
Analyze and Determine the Cause ďƒ˜ Avoiding claim denials involves a series of steps and the first one is to analyze and determine what causes claim denials in the first place. ďƒ˜ Right from the frond-end to back-end services, there are several operations, which if not carried out properly can resort to claim denials. They are as follows,
Patient Registration
ďƒ˜ This is the very first step when a patient visits a healthcare practice and if it is not shown proper care, then there can be a huge amount of claim denials.
ďƒ˜ Front-office staff should make sure that they register the patient details accurately while verifying their insurance benefits and eligibility.
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Coding: ďƒ˜ Accuracy in diagnosis and procedure codes is crucial to proper denial management. Carrying out the wrong diagnosis or coding incorrectly can result in a lot of claim denials. ďƒ˜ It is for this purpose that healthcare practices should offer enough training to their staff to carry out unsurpassed medical billing functions as per the new coding techniques.
Billing ďƒ˜ Sometimes, staff submit duplicate claims meaning they file a claim for a service more than once. ďƒ˜ Such internal mistakes are perfectly avoidable and the denial management team should check twice before the claims are filed.
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Filing ďƒ˜ Claims have a certain time limit before which they have to be filed. ďƒ˜ The time limit varies from payer to payer. ďƒ˜ Insurance companies will deny the claims simply if they are filed beyond this time limit.
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Payer: After analyzing all the factors, if there are no mistakes from the Providers’ end, then the denial management team must look into the Payer. Sometimes, payers make errors while processing the claims. If so, then call the respective insurance company and address the issue.
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Prioritize
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Once Providers fix the root cause of their claim denials, they should set up a good denial management team. The team will further analyze which factors cause the highest impact and prioritize. The causes are then eradicated one by one in the order of the prioritization
Claims Management Software
Yet another important step in managing claim denials is setting up a proper claims management software in to your system. The denial management team should use data analytics and study the pattern of claim denials to optimize the software and offer great solutions. This enables healthcare practices avoid claim denials in the future.
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About MGSI: All the aforementioned steps can be done proficiently by a reputed medical billing company. Therefore, partnering with one will save ample costs for healthcare practices. If you are looking for a highly-experienced organization then look no further than MGSI, a one-stop-shop to all your medical billing needs. This Florida-based company has more than 20 years of experience providing exceptional denial management services to its clients. To learn more details, log on to www.mgsionline.com.
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