3 TRICKS BY MEDICAL BILLING SERVICES TO AVOID CLAIM DENIALS

Medical billing services constantly fight with the monster of denied medical claims. Denied claims top the list of factors that restrain efficient revenue cycle management. These have been a constant threat making the efforts of medical billers and coders to go in vain.

The claim rate has cost millions of dollars to the healthcare industry. Insurance companies reject hundreds of claims each year over minor issues. Not just big established medical billing companies do this mistake, but small practices also have a huge share in it.

Having said that, denied medical claims can be recovered with little care and organized follow-up services.

How to Accelerate RCM?

Hospitals and medical billing services can manage to increase revenue by eliminating all the reasons that cause denied claims.

Medical billing companies appeal for the denied claims, but it requires a lot of time and investment. It can also lag behind the rate of creating new medical claims.

How can medical billing services manage Denied Claims?

A simple solution is to recognize areas that are causing denied medical claims. Medical billing services can never optimize revenue cycle management unless they rectify those problems.

Given below are three easy ways to avoid denied medical claims.

Verify Insurance Benefits

One of the major reasons for denied medical claims is the problems in the patient’s benefits. Moreover, there are also some other reasons such as, deductibles, copayments, and secondary insurances that shake up the claim’s status.

To avoid all these issues, medical billing services need to verify the patients’ demographics along with the credentialing status of the physician. Also, checking all the information given by the insurance panel is mandatory.

Verify If Healthcare Provider is among the Insurance Network

Sometimes, the healthcare providers’ are not in the network of the insurance company. It can be a problem causing revenue leakage.

In addition, clinicians don’t know about the variance of the reimbursement rates in the insurance plan. There can be many factors that affect the variance.

For Example,

  • Location of the healthcare provider
  • Number of medical claims
  • Medical expertise

Medical billing services should check the insurance payers’ contract with the physician. These contracts specify under what rules and guidelines, the insurance company will pay. Coverage policies, referrals, pre-authorizations are also included in the contract, clearly stating the benefit plans to the patients.

The insurance payers’ contracts are legal documents but are negotiable. For maximizing the revenue cycle management, healthcare providers should efficiently explain their expertise to the insurance companies.

Keep Track of Accounts Receivable

A healthcare facility can’t run smoothly when they have pending accounts receivable. Keep track of the claims if they are paid or not. Follow-up services play a crucial role in revenue cycle management.

If a claim is not being paid within 60 days, medical billing services should directly get in touch with the insurance company. It helps in determining the status of the processed claim, or the claim will end up as a denied claim. Moreover, it also helps in reducing the rate of wear-out medical claims.

If the claim has been paid, record its date, if rejected, go for the appeal process.

The responsibility of medical billing services is huge. Denied medical claims disturb revenue management of not only physicians but also the medical billing companies. To decline the rate of medical claims denial, above-mentioned tricks reduce administrative errors. Consequently, investments and efforts are not wasted unnecessarily.

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