Claim Denials are inevitable in-spite of various quality checks and measures in place. Nevertheless, keeping the claim denial ratio reduced and under control depends upon having an effective Denial Management Service in place. This articles guides on how to reduce rejections and claim denials in Medical Billing with Effective Denial Management Process.
Before we discuss on ways to reduce claim denials let us understand the top reasons causing claim denials in Medical Billing:
- Missing or Incorrect patient details
- Missing or incorrect provider and payor details
- Duplicate Claims
- Services already covered
- Service not covered under the patients insurance coverage
- Missed Timely Filing Limit (TFL)
Mentioned above are the major reasons for claim rejections and denials which can be apparently controlled with conscious efforts and streamlined process in handling the Revenue Cycle Management. Listed below are few tried and tested steps to be persistently followed to gain the targeted standard of quality claims.
Accurate Patient Demographic
Majority of the denials are due to incorrect patient details. This can be fixed by getting it correct during the patient registration itself to avoid to and fro checks and follow ups. Getting them right at the first step avoid many headaches later. Following the below list of patient information to be collected during the registration can help streamline the process and avoid missing out on any mandatory data.
- Patient Name, Age, DOB, Gender, Address and Contact Number, Email along with relationship with the policy holder.
- Insurance Name and contact details, plan details, policy start and expiry date, policy coverage details.
- Allergies or major medical history
- Copay, Co-insurance and Deductibles as applicable on the insurance covered
- Payment method for patient responsibility
Having a checklist will avoid on missing primary data needed for claim processing, thereby reducing the denial possibilities.
Quality Coding and Charge Entry
Medical Coding are mostly vulnerable to errors leading to major reasons for claim rejection and denials. And the process of Charge Entry in Revenue Cycle Management is not just doing the data entry of charges, but also to add value by identifying any issues with the claims, procedures or fee schedule and making necessary correction to enhance the claim quality. Having quality checks and regular audits and bring down the error percentage in these scopes and enhance first pass rate.
While the above mentioned point may help out in processing cleaner claims. Managing claim denials are also the primary focus to re-process and achieve the targeted revenue. This can be achieved with effective denial management steps as discussed below.
Claim Audit and Analysis
Performing a complete analysis of denied claims to identify the reason for rejection and working out to curb further such erroneous claim and educating the related team is a process flow that needs to be part of every Medical Billing Services.
Timely Re-submission of claims
Every claim has a dead line called as the Timely Filing Limit (TFL) for submission with Insurance Company. Effective Denial management aims at processing the rejected and denied claims within the stipulated TFL to avoid further hassle due to late submission.
Effective Account Receivable Follow up
Timely and regular follow up with Insurance companies by the accounts receivable team helps in expediting the claims reimbursement process. Effectively following up requires additional time and effort to be invested by a dedicated team.
Outsourcing Denial Management to Medical Billing Company
The best solution to reduce claim rejection and to handle claim denials effective is by partnering with an experienced Medical Billing Company who can handle the Accounts Receivable and Denial Management Services for you while you can focus on patient care.
About MGSI
MGSI is a 25+ year old national Medical Billing and Revenue Cycle Management Company located in Tampa, FL. With cumulative years of expertise serving more than 600 physicians across the US, MGSI has the latest tools in place with experience working on multiple Medical Billing Software. A multi- specialty Medical Billing Company guaranteeing maximum benefits and Cost Effective Revenue Cycle Management Solution. To know more about MGSI call 877-896-6474 or login to Healthcare Denial Management – Medical billing Services| MGSI (mgsionline.com)