medical billing services, medical billing companies, medical billing and coding, credentialing services

3 Ways to Avoid Denied Claims in Medical Billing

Denied claims have remained threats for physicians and medical billing services for all these years. Although, we have seen billers and coders play with different strategies and physicians opting in-house medical billing. However, we still have not succeeded in getting that perfect formula.

Denied Claims Affect Revenue Cycle Management

We read many reports almost every year that highlights the issues in our healthcare industry. Moreover, we are not oblivious that hundreds and thousands of dollars are lost every year. Of course, rejections from insurance companies are a major reason for that.

The situation is even worse when you move up the ladder in the healthcare industry. It means that large healthcare organizations have to face high consequences for their small mistakes in medical billing services.

What Is the Solution?

With carefully derived data-driven strategies and efficient follow-up services, medical billing companies compensate for the loss.

Here are three important strategies to reduce revenue leakages. The perfection is in detail that majority of physicians ignore and fall victim to denied claims due to poor medical billing and coding.

Know the Insurance Coverage & Network Status

Sometimes the problem does not lie in the billing and coding practices but in the authentication process. Yes! If an insurance claim does not support the rendered services, why will the insurance company pay for it!

The issues with the patient’s healthcare plan benefits are one of the major reasons that result in denied claims. Another administrative issue is the physicians’ demographics and credentialing services.

Often immature medical billing service companies don’t have the proper paperwork, and it causes them to fall short of the network requirements.

Moreover, deductibles, copayments, primary and secondary insurances plans, all contribute to affecting claim processing. Thus, outsource the billing process to professionals, so they keep a check on the relevant information beforehand.  It causes lesser issues afterward.

Physician’s Insurance Contract

Yes! Denied claims can be reprocessed, but it’s a whole lot of effort in the same source. So, why not ensure every data requirement at the first time to avoid inconvenience in the later process.

For instance, some networking contracts abide healthcare professionals to a certain degree of reimbursement rate.

Location of the medical practice, medical specialty, and the volume of the claim influence the performance of medical billing services. When clinicians enter any insurance payer’s contract, they must know every specific in detail.

These contracts have insurance coverage details, including prior authorizations, procedures, and referral policies. If you do not comply with any of this information, negotiate the term with the insurance company.

Thus, to maximize profits, it’s better to negotiate terms and conditions. They can demonstrate their quality of services. It helps to outsource medical billing companies to get payments easily.

Keep Check on the Accounts Receivable (AR)

If a medical practice does not keep a check on their account receivable, they are risking their performance. A streamlined workflow translates into a profitable revenue cycle, and it should be taken seriously.

By maintaining logs of your efficiency and claims, medical billers and coders know about their financial performance and follow up on the denied claims. Professionals generally record the claims submission date and their expected payments alongside.

This step helps verify the claim status. The claims that are not reimbursed even after a certain time, you know they have been denied, and you can follow up on them.

Missing Out on Important Information

Another thing is even if you know about insurance coverage and network status, missing out on single information can claim denial. Medical billing services also have to ensure the accuracy of technical and demographical information. Moreover, the use of the wrong modifier or social security number also results in rejection.

Medical practices, sometimes, also don’t pay attention to due dates of claim submissions, a common problem that happens in in-house medical billing and coding.

However, some insurance companies require it. Hence, the automated billing process keeps things going.

If billing and coding experts stay careful about these things, there is a chance to reduce accounts receivable in the majority.


If hospitals and physicians wish to efficiently run their cash flow, they must have a zero or very low denied claims rate. On the contrary, appealing for denied claims requires reinvesting of efforts. The same energy medical billing services invest in reprocessing of denied claims can be invested in compiling new clean claims.

Thus, the only solution is to get to the problem cause and rectify it for once and all. Medical practices, irrespective of their size, can optimize their medical billing practices and put an end to revenue leakages.

2 replies
  1. Daryl Jude
    Daryl Jude says:

    What are three effective strategies to prevent denied claims and optimize the success rate in medical billing processes?

    • Dr. Richard Paul, MD
      Dr. Richard Paul, MD says:

      Three effective strategies to prevent denied claims and optimize the success rate in medical billing processes are: ensuring accurate and thorough documentation, staying updated with coding and billing regulations, and conducting regular claim reviews and audits to identify and rectify errors before submission.


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