Let’s be honest for a second. Although a noble thought, aspiring to reduce claim denials to zero is probably impossible. The way the healthcare system works makes it prone to errors. As a result, almost any hospital and medical practice will be dealing with denials at some point, regardless of how much care and attention they put into their patients’ claims.
While denials are a component of the healthcare system, that doesn’t mean that there aren’t measures you can take or technology you can employ to minimize the impact they have on your bottom line.
Here are a few tips for optimizing your claims denials measures and working on prevention strategies.
1. Identify the Root Causes for a More Efficient Denial Prevention
Denials are frustrating, but they can be prevented and fixed. While it might take more time and effort, the first thing you should do is investigate the cause of the denials. Putting the time aside to establish and understand the reasons that led to a denial will help you develop more accurate prevention methods.
Whether it’s a string of mistakes you make while filing claims or just a simple reporting error, figuring out the source of the problem will make oversights and slip-ups harder to repeat.
For example, some of the most common reasons for denials are incomplete or incorrect information submitted on the claim, requesting services that are not covered by the payer or have already been adjudicated, submitting claims more than once, or doing it outside the required timeframe.
2. Prevent Errors through a More Accurate Up-front Information Collection
As previously mentioned, one of the most prevalent reasons for denials are filings that are incomplete or incorrect. That falls under the front-end revenue cycle management, which includes registration, scheduling, and reporting. It is crucial that the information you collect at this stage from your patients is complete and accurate. Doing so will make the entire claim billing process more efficient and more likely to go smoothly.
3. Streamline Claim Denials Management
A recent report shows that half of healthcare organizations do not currently use any claim denials management tools despite the fact that technology today is so advanced that it can make handling claims simpler than ever before.
If you’ve ever appealed a denial, you know how tedious the entire process can be. You need to understand the reason for the denial, prepare for the appeal process, follow the payers’ appeal deadlines, and keep track of everything.
With the help of an automation tool, you can streamline this process and make it more efficient.
It is becoming increasingly difficult to keep up with every little detail, such as diagnostic codes or insurance policies, so why not implement software technology that will automatically do it for you, saving you a lot of time, effort, and money in the process. Your billing team will spend less time on research and more time on optimizing strategies.
4. Address Claim Denials Promptly
Due to the large volume of denials, a lot of medical providers have difficulties addressing them quickly or even at all. They wrongly assume that once a payer denies a claim, there is no chance for it to be corrected and appealing it will only garner the same result every time. This approach results in countless denials that the billing department never appeals, and contributes to significant losses for practices and hospitals.
Make sure your billing team’s daily workflow includes the revision of old, denied claims, as well. That way, they will be able to keep better track of claims and make necessary adjustments rapidly. Bear in mind is that submittal, as well as resubmittal of claims, are expected to be done in a certain timeframe. Each insurance carrier will have specific guidelines for filing denials, and it is crucial that you respect and follow them.
Missing the payer’s deadline is one of the reasons claims get denied, so always make sure to keep records of everything. Most importantly, be aware of your carrier’s timeframe. Typically, If you have a contract with the payer, timely filing denials can rarely be appealed, so it’s best you don’t miss any important deadlines since the payer will most likely have a clause in your contract that mentions they are not responsible for any claims they receive outside the specified timeframe.
Claim denials are a common and regular part of our healthcare system. They are also one of the reasons hospitals deal with revenue losses. Failing to correct and resubmit denials no doubt affects reimbursements. As a result, having a clearly-defined and well-thought strategy for claim denial management becomes paramount if you intend to maximize your profits.
If you have a difficult time managing denials, then maybe it’s time to look for a healthcare solution. Med-Strategies can become your strategic partner in helping you improve and elevate your practice experience as regards Loss of Revenues due to claim denials.