Medical billing services constantly fight with the monster of denied medical claims. Because 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 go in vain.
The claim rate has cost millions of dollars to the healthcare industry. And 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.
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.
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.
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.
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,
Medical billing services should check the insurance payers’ contracts with the physician. These contracts specify under what rules and guidelines, the insurance company will pay. The contract includes coverage policies, referrals, pre-authorizations, 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.
A healthcare facility can’t run smoothly when they have pending accounts receivable. So, 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, the above-mentioned tricks reduce administrative errors. Consequently, it also prevents wasting investments and efforts unnecessarily.
