Avoid Claim Denials: Here’s how

One of the major problems that most medical practices face is denial of medical claims. This is not only frustrating but also leads to a major dip in the revenues of the practice, which can have an adverse effect on it in the long run.

According to a survey, most practices spend a huge amount of money in making phone calls to the health insurance companies, to investigate the underlying cause of the claim denials and for denial management. This can further lead to the emptying of the coffers.

The best bet would be to avoid the denial of medical claims in the first place. Of course, there is no denying the fact that medical billing is complicated. However, paying a bit of attention to it can actually help you to avoid claim denials and wasting of time on claims reworking and resubmission.

Wondering how this can be done? Here’s how.


  • Automation


Keeping in sync with the ever changing codes and regulations of health insurance can be a harrowing task and an impossible one at that. However, not paying attention to these is what leads to denial of claims. Thus, the best idea to ensure that your practice is always at par with the regulations is to go for automated software that will automatically streamline all your codes and requirements as per the changes made. This will not only help you to bring down the number of claim denials but will also leave your staff with more time to focus on other activities like offering better care and services etc.


  • Team Management


A lot of times the cause of claim denials could be that the staff overlooks cross checking the reimbursement requests and thus sends these to the health insurance companies with errors. Thus, it is important that you set down some ground rules when it comes to submission of claims and instruct your staff to follow these rules diligently. Checking and rechecking of claim requests is sure to bring down the number of claim denials.


  • Investigation of Denials


It is definitely not a good idea to let the claim denials be left just like that. This is like letting your hard earned money go to waste. It is very important that you follow up the denial and find out the reason for the rejection in the first place. This will not only ensure that you get reimbursed but will also help you understand the reasons for the denials. Equipped with this knowledge, you and your staff can then work towards avoiding any further denial of medical claims.


  • Daily Claim Denials Management


It has been often cited that the staff of a medical practice is so focused on submitting the new claims that they overlook the need to address the denials. This is a definite no-no. The denials should be taken as seriously as the new claims and should be addressed immediately. Procrastinating the reworking of the denials is what sometimes leads to repeated denials of a claim.


  • Keep Tab of Changes


Even if you have a practice management software that streamlines all the data and addresses the inaccuracies, it is important that you and your staff too are in sync with the whole process and well versed with the changes that may come by. It is a good idea to subscribe for newsletters and magazines that keep you abreast with the various changes in the health insurance arena. By keeping tab of these changes, you and your staff can avoid denial of claims.

Checking the claims minutely before submitting them to the health insurance companies can help in avoiding errors and thereby denials. Consistency in attention and efficiency in claims and denials management is what will assure enhanced revenues for any medical practice.