Effective Tips to Avoid Claim Denials and Achieve Clean Claims

You do everything possible to submit clean and accurate claims. Unfortunately not all claims get through the first time. Huff! Claims denied – That’s the last thing you as a physician would like to hear from an insurance payer. Have you ever wondered why claims get denied? Claims get denied because they fail to meet payer requirements. But are you aware that most are preventable by simple changes? Well, data says that 10% of the claims submitted by medical practices are denied. But the good news is that a 2014 Advisory Board study says that 90% of the denials are preventable. Let us in this blog discuss some of the effective tips to stop, or at the least reduce claims denials in its tracks.

Verify eligibility

A survey has cited that 24% of the denials are due to eligibility issues. Hence the first and foremost thing is to check the insurance and eligibility of the patient. For this purpose you have to call the insurance provider and verify information with regard to in-network coverage and out-of-network coverage. Else it will delay your reimbursement process and increase your claim denial rates.

Check patient information

It is crucial to maintain accurate and complete patient data. Maximum claim denials happen due to improper patient information. So, take the time to cross-check that all information is correct and meets the insurer’s requirements. Double checking before submission reduces risk of claim denials.

Understand payer rules

Medical billing rules and regulations keep changing. Staying current makes the billing process easier and reduces the risk of claim denials. Each year, codes may be added, discontinued or new codes may replace existing codes. Failure to stay up-to-date on payer guidelines can significantly impact the cash flow of your practice.

Submit on time

Late filing of claims can result in denials. So, never miss a deadline. While seeing more patients may be great for your practice from a growth perspective, backlogs are a costly affair. Denials can mount up and become a serious issue, if you have a large backlog of claims and too many late filed claims. So make sure that claims are sent out on time.

Take advantage of technology

Take advantage of technology to ease your process and avoid denials. There are many systems available these days that can review claims and alert you if you are missing out on any information. This means that you need not focus too much on minute details and ensure that documentation required for claim submission is done the way it should be.

Track the claim

Conduct regular follow-ups of submitted claims. Claim processing goes through a series of steps. Make sure to track each step to ensure accuracy and approval. Else you will not be able to spot issues, if any, and find a solution so you get your claims paid. A more sensible approach is to work with a medical billing company who will closely monitor your claims and ensure that you get paid the very first time.

Know different payer rules

Each payer is different and follows different claim filing rules, deadlines, as well as follow-up procedures for denials. Hence having a clear understanding is important to avoid confusions. Some payers even insist on using specific forms and/or submitting through an online portal. And failing to do so may result in additional denials.

Choose to outsource

Managing claim denials and ensuring clean claim submissions is a challenging task. You will also have to spend your time and money on people and technology to set up the process. Hence, by outsourcing to a professional billing company you gain access to a team of billing experts who can help reduce your claim denials and ease your claim submission process.

As you can see, there is a lot of work involved in submitting a clean claim. The unfortunate reality is that, no matter how hard you try to make everything perfect, claim denials do occur. That is why many practices struggling with denied claims have turned to outsource in order to optimize claim management and keep their revenue cycles moving smoothly. We at Scribe4Me have a highly skilled and experienced team of billing experts who are trained to handle the nuances and complexities of medical billing. We make sure that your claims are processed seamlessly so that you achieve cleaner claims and avoid denials.