Medical Billingclaim denials management

One of the major problems that most medical practices face is the 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 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 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 avoid claim denials and wasting time on claim reworking and re-submission.

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


Top 5 Ways to Avoid Medical Claim Denials


  • Automation


Keeping up with the ever-changing codes and regulations of health insurance can be a harrowing and an impossible task. However, not paying attention to these is what leads to denials of claims. Thus, the best idea to ensure that your practice is always in compliance 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 lay out some ground rules when it comes to the 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 on 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 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 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 practice management software that streamlines all the data and addresses the inaccuracies, it is important that you and your staff are in sync with the whole process and well versed in the changes that may come. It is a good idea to subscribe to newsletters and magazines that keep you abreast of the various changes in the health insurance arena. By keeping tabs on these changes, you and your staff can avoid denials of claims.

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

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