Medical Billing Denials are the most common concern of every practice. Claims denials and rejections are inexorable however they can be controlled to a greater extent with necessary steps and obligatory checks. Let us discuss in detail the causes of claims denials and some tips to avoid them.
Most common reasons for Medical Billing Denials:
A claim can be denied for several reasons as listed below.
- Incomplete documentation
- Missed Insurance Eligibility Verification
- Missed Prior Authorization
- Error in Patient Demographics
- Incorrect and inconsistent Medical Coding
- Mistake in Charge Entry
- Claim filling error
- Inaccurate billing or coding data
- Missed AR follow-up on the denials resubmitted.
- In-efficient Denial Management.
Efficient Denial Management is the key to a successful Medical Billing Process. Claims denials and rejections can significantly hit your revenue goals, therefore it is essential to understand the Claims denials and Claim rejections difference and the reason. Understanding the root cause can help implement corrective measures to curb repeated instances of denials for the same reason. Additionally, it also helps upgrade your existing process flow and streamline it to the current and changing requirements. Listed below are a few tips to reduce denials and enhance your overall billing experience
Tips to Avoid Medical Billing Denials
Keep a Close Watch on Insurance Coverage Updates and Changes:
Insurance coverage policies are updated and changed constantly. Medical practice is expected to keep itself current with the changes and render patient services accordingly. This can mean that reimbursement for the service rendered takes a toll if you are not aware of the particular carrier coverage details.
Complete Documentation of Medical Reports:
Accuracy and completeness in the documentation of procedures and services rendered are fundamental and cannot be compromised, as it is a known factor that can outright affect your claim reimbursement and also lead to claims denial or rejections. Technological development has many tools to aid providers in these niches, upgrading your current setup with the latest automation of process minimizing claims denials, and yielding notable increases in revenue generations.
Upgrade to Automated Solutions:
Healthcare Technology upgrades have rendered great tools for the automation of many areas in Medical Billing and Revenue Cycle Management. Investing in the right tool can reduce possible human errors with permanent solutions for most denial and rejection causes.
Internal Audits and Checks:
Even experienced billers and coders tend to err while processing multiple claims on a day-to-day basis. Claim errors can occur involuntarily or because of not being top of the recent changes, irrespective of the cause for denials it can be controlled by having a regular audit of claims processed. Process audit should be an essential part of any revenue cycle management process.
Insurance Eligibility Verification:
The first and foremost step in Medical Billing to reduce your claims denials is verifying Patient Insurance Eligibility. By verifying Insurance Eligibility you have control over the services to be rendered based on the insurance coverage terms and plan your payment collections accordingly.
Outsourcing Medical Billing Services:
Medical Billing Companies have the expertise in processing claims more efficiently with experience in handling claims for multiple insurances and various medical practices and groups, which helps them stay atop the changing rules and regulations to keep their billers and coders updated to meet the ongoing requirements. Outsourcing Medical Billing has increased in recent times owing to the benefits in comparison to in-house billing. Research has proved Outsourcing to be the best choice to increase revenue in Medical Billing.
About MGSI
MGSI is a 29 year old national Medical Billing Company in the US. MGSI has trained and experienced medical billing and coding team handling complete Medical Billing services to our clients. To know more about the benefits of outsourcing your RCM process to MGSI contact us today at 877-896-6474 or visit our website www,mgsionline.com