Accounts Receivables (AR) management is one of the most important aspects of the healthcare industry allowing practices to retain cash flow (money in, money out) and sustaining financial stability. One of the biggest challenges faced by healthcare providers is claim denials, which can result in payment delays, high administrative costs, and even revenue loss. Reducing claim denials is critical to enhancing AR performance and optimizing revenue cycle management (RCM).
This blog covers the most typical reasons why claims get denied and important approaches to lessen them, so healthcare practices can realize AR success.
How to Reduce Claim Denials?
Error in which the insurance payer refuses to process or pay a claim that was submitted on the ground of errors, non-compliance, and other reasons. They are generally split into one of two types:
- Hard Denials: They are final and lead to revenue wastage. Examples include no coverage or submitted late.
- Soft Denials: These are temporary denials that can be addressed, rectified, and re-billed for payment. Examples are claims denied for lack of documentation or coding errors.
Top Reasons for Claims Denial
Understanding the reasons behind claim denials is the first step in reducing them. Some common reasons include:
Missing or Inaccurate Patient Information: Errors in patient demographics, insurance details, or verification of coverage can cause denials.
Authorization Problems: Denials may also result from not obtaining a prior authorization for specific treatments, tests, or procedures.
Coding Errors: Another common reason for a claim denial is the wrong, outdated, or mismatched CPT, ICD-10, or HCPCS codes used.
Submission Errors: Claims submitted after the payer’s deadline, or submitted without all required documentation, may be denied.
Denials of Medical Necessity: If a payer determines that a procedure or treatment is not medically necessary, the claim may be denied.
Duplicate Claims: There are situations where you would receive a denial if you’re submitting duplicate claims.
Coordination of Benefits (COB) Issues: If there are errors in determining primary and secondary payers for the claim, it may get rejected.
So How Do You Say Goodbye to Those Denials?
So practices can take a proactive approach to make sure that they cut down on reducing claim denials and improve AR outcomes. Here are some key strategies to help make this happen:
1. Simplify Insurance Eligibility Verification
The first step to stop insurance claims from being denied is the verification of patient insurance coverage. Key actions include:
- Confirming coverage details like co-pays, deductibles and benefits.
- Verifying pre-authorization for certain treatments.
- Automating the process with sophisticated eligibility verification devices.
2. Enhance Staff Training
Staff that are well-trained are a significant factor in minimizing claim errors. Ensure that your team:
- Familiar with the guidelines for medical coding and billing.
- Knowledgeable on policies and requirements specific to each payer.
- Keeps current with CPT, ICD-10, and HCPCS code changes.
3. The key is to ensure accurate coding practices.
Coding accurately helps avoid denials. Key measures include:
- Using certified coders to confirm that procedures and diagnoses are coded accurately
- Conducting regular audits to identify and resolve coding mistakes.
- Using a coding software to help accelerate the process and minimize manual errors.
4. Obtain Prior Authorizations
For procedures requiring prior authorization, do the following:
- Give the insurers ample time to approve any needed authorizations for the procedure.
- Maintain detailed documentation of each communication with payers.
- Ensure that the authorization is about the specific procedure and date of service.
5. Submit Clean Claims
Error-Free Claims Submission to Avoid Denials To achieve this:
- Utilize claim scrubbing tools to find and fix errors prior to submission.
- That means all of the necessary documentation is filed.
- Verify patient information and coding is correct.
6. Monitor Denial Trends
Patterns of denial can indicate where problems are repeating. Actions include:
- Categorizations of reasons for and frequency of denials.
- We’re finding trends and root causes with analytics tools.
- Taking immediate corrective measures according to the findings.
7. Leverage Opportunities in Accounts Receivable (AR) Follow-Up
AR follow up works best when claims that have been denied are dealt with timely. Key practices include:
- Having special teams to follow up on denied claims.
- Following up based on how much is claimed and how old the claim is.
- Optimizing Accounts Receivable (AR) with IT Solutions
8. Develop Solid Communication with Payers
Maintaining open lines of communication with payers ensures issues can be resolved quickly. Steps to take include:
- Creating a direct line of communication with payer representatives.
- Payer policies and updates should be routinely reviewed.
- Getting together on a scheduled time to discuss ongoing issues.
9. Leverage Technology
Advanced billing software and analytics tools can also help reduce claim denials. Benefits include:
- For automating eligibility verification, coding, and claim scrubbing processes;
- Real-time insights into AR performance and denial trends
- Improving workflow and minimizing human errors.
10. Outsource Medical Billing
A professional medical billing company can also help practices focus on their business priorities without losing sight of AR outcomes. Benefits include:
- Acquire focused knowledge around denial management and revenue cycle management (RCM).
- Less overhead costs and less administrative burden.
- Greater adherence to payer guidelines.
The Role of Synergy HCLS in Reducing Claim Denials
Synergy HCLS provides end-to-end medical billing services to reducing claim denials and enhance AR performance. Our services include:
- Eligibility Verification: Guaranteeing accurate insurance verification so as to avoid mistakes.
- What we do for the coding accuracy: Making use of certified coders for proper coding.
- Denial Management: Efficiently tracking and reducing claim denials.
- Technological Incorporation: Utilizing the latest technologies to optimize billing systems.
- Customized Support: Solutions for individual need of practice.
Synergy HCLS help providers revamp the revenue cycle, reducing claim denials, and get to AR success.
Conclusion
Have your claims Denied — Here is how to reducing claim denials? This blog outlines actionable steps practices can take to reducing claim denials, reduce billing errors, boost AR, and achieve their payables! Strategically addressing denial prevention and management will lead to long-term healthcare success, whether done internally or by utilizing an expert partner like Synergy HCLS.
