Practices That Can Help In The Reduction Of Claim Denials

For any medical organization to thrive it is of utmost importance that they take care of their patients and ensure that none of their needs goes unlooked. A hospital can become better when they keep their promise of delivering top-notch medical care to their patients. However, they also have to make sure that their financial health remains in a good condition to be able to deliver those promises. If a hospital does not focus on their claim denials it can affect the total amount of revenue earned by them. Before diving into the topic of the ways that you can reduce claim denials understanding what exactly is the process of denying a claim is crucial.

A Basic Understanding of Claim Denial

When a claim gets submitted by the healthcare organization to the insurance payers in order to get reimbursed for the services they have provided to their patients the insurance company can reject their claims on certain grounds. The majority of the time the reason for the rejection is when the medical claim tends to have missing data or incorrect coding. 

ICD-10 codes are an important aspect of the medical world. Medical coders need to be well-versed in medical coding lest they get denied by the insurance companies. It is a tedious job to go through each of the codes but it is also the key to getting the proper reimbursement for all the services that have been provided by the hospital. In order to reduce medical claim denials, keep on reading about the tips that have been shared in this article. 

Ways To Reduce Claim Denials in Medical Billing

How do I reduce denials in medical billing?

When you hire a medical billing company, they must be aware of the medical billing rules that must be followed to ensure that the medical claims do not get denied.

1. Using codes that ensure the highest amount of specificity

In order to ensure that the claim denials remain as low as possible using the right codes during medical diagnosis is of utmost importance. This allows for the highest amount of specificity which results in lesser claim denials. Clinicians that tend to choose medical codes must do so accurately to leave no gaps among the claims. Henceforth, the ICD-10 codes should contain the fifth-digit subclassification. One thing that must be remembered is the fact that when the subclassification for fifth-digit medical codes is not available 4-digit codes can be used as a replacement.

2. Ensuring there is eligibility and insurance coverage

Scheduling a patient’s appointment with the doctor is all well and good, however, it is the job of the front desk to make sure that the patient’s treatment is covered by the insurance along with the proper coverage of all the eligibility benefits in case the claim gets denied by the insurance company. In a number of cases, obtaining authorization or referral might be mandatory since these claims have a risk of getting denied. Authorizations tend to be active during a specific time range and if it is not used by then, it gets expired. They tend to cover the number of visits or treatments that have been received by the patient in between a certain period of time.

But you should also remember that having prior authorization does not clear the risks of having your claim denied. The claim that you submit must also fulfil all the other requirements.

3. Staying updated with all the requirements

Medical billing regulations and rules are going through constant changes which is why it is crucial to stay updated at all times. Your best option would be to choose a medical billing company that trains its staff with continuous education and teaches them all the things they should know about the latest software that can help medical billing and code a lot easier. There are many steps in the revenue cycle management and doing every step precisely will make the reimbursement process faster. In medical coding a lot of the time, certain medical codes get discontinued which is why staying up-to-date with the updates is of utmost importance.

4. Timely filing of the claims

Each of the insurance payers tends to have different pre-requisites when it comes to the submission of the claims. It is important to file the claims within the time period that is given by the insurance payers, if that is not followed then it can lead to problems with the reimbursement. Missing the deadline can lead to the rejection of claims. Use the patient’s schedule as a guide to starting with the filing of the claims on time without missing the deadline. Experienced medical billing staff tend to have an established process that guarantees the proper submission of medical claims.

5. Tracking the medical claim until the reimbursement process

It is important to keep a track of each of the medical claims right from the beginning to the end of the process. This way if there are any problems that do arise during the process it becomes easy to identify them and then solve them. This way the claims do not get rejected and the reimbursement process goes smoothly without any hiccups. An esteemed doctor from the University of California conducted a study where they found that the majority of the medical practices tend to spend around 10 to 14 percent of the entire revenue on rejected claims. 

Why Do Medical Billing Denials Take Place?

What is Claim Denial?

The majority of the time the main reasons for medical billing denials are the following;

1. Duplicate service or claims

Claims that get resubmitted by the same medical provider on the same date for a similar service item and the similar beneficiary are known as duplicates. These constitute up to 32% of the medical claim denials.

2. Misplaced information

Even if there is one blank field on a medical claim it can lead to a denial. Technical errors, wrong coding or not providing the social security number leads to medical bill denials.

3. Already adjudicated service

If a service has already been reimbursed then the insurance payer can reject the claims on this ground. 

A critical part of the RCM system, it is always important to have a look after the entire process of the medical billing claims. This is where a reliable and experienced RCM service provider like Synergy HCLS can make a huge difference in how your healthcare business performs.