Successful Strategies for Overcoming Denials in Medical Billing
It is a fact that denials are a routine part of medical billing and are experienced by most healthcare providers. It does not matter whether your practice is big or small or if your hospital is small or large; everything depends on how you manage the process of claim denials effectively. This article helps you with practical strategies on how to manage and overcome denials in medical billing effectively so that the bottom line of your practice remains healthy.
Understanding Denials in Medical Billing
What Are Denials in Medical Billing?
Denials occur when an insurance company rejects a claim made by a doctor or health professional for payment of services. These denials are time-consuming, frustrating, and can have a detrimental influence on your practice cash flow. The starting point for the proper management of denials lies in understanding the most common reasons why they occur.
Common Denials in Medical Billing
- Prior Authorization Problems: The lack of prior authorization in advance for the service is grounds for denial of a claim.
- Incomplete or Invalid Details: This can either be blank fields or invalid codes, which can be a basis for denial.
- Medical Necessity Policies: According to the payer, a claim might be denied on the ground that the service provided is not medically necessary.
- Services “that are not covered”: Sometimes the procedural code will not be a covered service under the patient’s insurance plan.
- Out-of-Network Providers: Out-of-network services may be denied.
- Duplicate Claims: Filing more than one claim for the same treatment could be denied.
- Coordination of Benefits Issues: Denials occur in case of problems with multiple insurance plans of a patient.
Denial Management Effective Strategies
Review all notifications properly
If you do receive notification about the status of a claim, read it. Look for any detailed explanations of why the claim was denied and for any instructions on how to resubmit or how to appeal the claim. Knowing the reason or reasons for denial may help you to better address the issue.
Persevere in Appeals
If your claim has been rejected and you believe that the decision is incorrect, do not hesitate to appeal. When initiating an appeal, make sure to follow the insurance company’s guidelines and include all the required documentation. Your persistence can often result in a reversal of the denial and successful payment.
Act Quickly
Timeliness is key to proper denial management. All claims and appeals have to be submitted on time, as indicated by the respective insurers, to minimize any further complications. A delay may further exacerbate a denial or reduce chances of recovery.
Each insurance carrier will have its own appeal process. Be aware of each process and keep current on all policies and procedures of each carrier to be able to respond accordingly, in addition to fulfilling the requirements of that aforementioned carrier.
Maintain Good Record-Keeping
Maintain detailed documentation for all correspondence with insurers regarding the representatives’ names and information from your discussion. This documentation may be very useful for escalation of the appeal or further action.
Use Best Practice
Adopt best practices within your billing processes to minimize denials. Regular claims audits should be part of the process to overcome denials. Information about the patient needs to be continuously verified. Stay abreast of information with changes and updates in payer policies and procedures. Train your staff and, in some cases, avail services related to denial management as well to be competitive and can work on improving the ratio of claim acceptance.
Leveraging Technology to Manage Denials
Use Claim Scrubbing Tools
Use claim scrubbing tools or software to scrub for errors prior to submission of claims. Such tools are input-sensitive and will check to see if some information is missing or correct, which ensures submitted claims are as accurate as possible.
Invest in Coding and Compliance Solutions
Coding software solutions will help your claims be produced accurately and in compliance with all applicable rules and regulations. You will be able to reduce instances of denials due to poor coding.
When to Outsource Denial Management
Denying or rejecting payment for a claim always seems an inconvenience and a waste of time for all concerned parties. Outsourcing denial management has been one of the best solutions for managing claims that have been denied if a practice has a high rate of claims that get denied or rejected. Companies like Doctors Back Office provide specialized denial management to work on use effectively.
Still suffering from rejections in medical billing? It’s time to cush up with some energy: DoctorsBackOffice to take that weight off your shoulders. Denial management services are set up to ensure that all your claim rejections are taken care of to realization—thus payments—that ought to be with you. Contact us now to understand and be able to appreciate the difference we can make to your practice’s health in terms of financial support and the speed of your billing operation.
Do contact DoctorsBack Office today for optimized denial management and thus enhanced revenue cycles!
