In the medical industry, there are numerous expenses that practices must pay as part of the territory, but none of them hit medical practices harder than claim denials. Most practices have to go about the claims denial process manually, which leads to giant administrative expenses and lost payments. The reason for this is that denied claims themselves are difficult to interpret and require a large amount of effort to fix.
Unfortunately for medical practices, claims denial is a common occurrence. If a practice wants to ensure that its getting paid for the services that it rendered, it needs to then go through the denial management process.
Thankfully for medical practices, advances in technology and medical coding have allowed them the opportunity to automate their claims denial process. By taking the following four steps, you can streamline your claims denial process and save yourself a lot of time and money:
Develop Automated Claims Denial Management Process
According to studies, nearly 75% of practices still use a manual process for claims denial management. These practices are bogged down by various diagnostic codes and insurance policies that are usually very exhausting to try to navigate within a manual system.
Instituting an automated process allows medical practices which still use a manual claims denial management system to download and install software that can automatically update requirements and medical coding. This heavily reduces the amount of research time used and allows your billing team to use their time a more productive manner, like double-checking all your claims to ensure that they meet all the requirements necessary to be approved. Operating with an automated system benefits the patient and improves patient satisfaction levels.
Tools that help facilitate data analytics are also crucial to streamlining your claims denial management process. By providing your billing teams and providers with clinical data, you allow them to work more efficiently on creating improvement strategies. With analytics dashboards, claims-level data, and interactive reports; providers can use their data analytics to analyze medical coding and prevent issues before a claim is submitted.
Estimate Insurance Coverage
It’s been estimated that nearly 80% of medical practices only check up on a person’s eligibility for a claim before the first in-house appointment, and only 25% check their eligibility during any visits after the first one. This is a huge contributor to high claim denial rates, putting the proactive responsibility on the billing staff and management of the front-end revenue cycle. They can help prevent this from happening by making sure to verify any information about insurance and patient demographics during the preregistration process.
There are estimating tools available today that allow for practices to check and collect money up-front based on the reason for patient visits and the amount of copays and deductibles before the claims are adjudicated. These allow practices to collect money upfront and not have to spend time and effort to send patient statements, etc after the patient has left the practice. If your software vendor does not provide these tools, please reach out to Med-Strategies to understand the tolls available to help you with this activity.
Check Your Results
Once you have your automated claims denial management system up and running, check your results to see what kind of impact it’s having on your bottom line. If you have a system that was built in-house, check around with companies to find out what kind of results they could bring you and how your system compares to what they could do for you.
If you have an in-house system that is working, but not operating as efficiently as you expected, consider using a third party for your claims denial management.
Use a Third Party
For many medical practices, automating your claims denial process can be more trouble than it’s worth if they choose to build a system in-house. For these practices, the best option is to go with a third party company.
Companies like Med-Strategies have years of experience in dealing with claims denials and have a vast amount of expertise in reducing and managing them. Going through a company like Med Strategies will help you increase your expected revenue while dodging the lengthy, error-filled, process.
Automating your claims denial process might seem like a lot of work, but it will end up saving you time and money. By developing a solid process for automation, estimating insurance coverage upfront, and checking your results, you will be well on your way to eliminating a significant portion of your claims denials.