How to Avert Medical Billing Claim Denials?

Medical billing denial is the rejection of a claim by an insurance company made by any individual or by their provider, to pay for the rendered health care services. If you are a financial administrator in a hospital or any other healthcare facility, you would have an idea about the complications involved in medical billing claims. The denial of such claims proves to be a continuous headache as they affect the credibility, cash flow, and overall efficiency of a healthcare provider.

Studies suggest that the annual medical billing claims denials for hospitals stand at 2 percent, whereas, for medical practices, the percentage increases up to 10 percent. This makes the medical practices less profitable by comparison.

Some of the healthcare organizations even undergo a denial rate of 15 to 20 percent, which is considered extremely high. This means that providers facing this kind of denial rate have one out of five medical billing claims denied.

Overview and Tips for Provider Credentialing Process

Provider credentialing is critical for authenticating expertise, experience, willingness, and interest in providing medical care. If you are not able to follow the provider credentialing process, it can result in delay or worse, denial of the provider payment.

Provider Credentialing Process

It is not one of the formalities that you have to complete or a form that you need to fill. It is an ongoing process that involves a lot of complexities. Therefore, you need to closely follow all the requirements. There are many steps that you need to follow in order to qualify for credentialing. Also, it is essential for your business that you practice without any hindrances.

Besides the simplistic definition, it also involves submitting a lot of documents and forms to various third parties for verifying your practice. You do not need to follow the entire process each year. However, you must provide annual updates.

Medical Billing – Over 50% Americans Can’t Afford to Go to the Doctor

The sorry state of affairs in the American medicare industry reflects the inability of many Americans to afford quality healthcare. Many can’t afford medical billing despite having insurance. The Obamacare premiums are making it difficult for them to continue with the payments.

Can’t Afford To Go To the Doctor – HealthPocket

A recent survey by HealthPocket revealed the difficulties that many Americans face. The Affordable Care Act is reducing people’s ability to afford health insurance. They have so many other expenses that they can’t afford take out money for health insurance.

The survey results show that a lot of Americans can only afford $100.

Here are the results.

  • Around 52.5% say that they can only afford $100 or more.
  • Only 15.95% can afford $200 each month.
  • The number of Americans drops 11.6% who can pay $300 each month.
  • The percentage further reduces to 5.5% for $400 health insurance deductible assistance.
  • Only 4.8% say they can set aside $500 each month.
  • Only one out of ten Americans, or 9.8% say that they can give away $500 a month for health insurance.