How to Prevent Claim Denials in Healthcare Billing Services?

2020 was an overwhelming year for the healthcare industry. Medical practitioners have been facing several challenges on all fronts. They find it very difficult to manage the healthcare billing services due to the rigid coding rules and major technological breakthroughs. 

However, it is also a fact that you cannot afford to ignore the significance of the current evolutions. Because it is very crucial to keep the process of claims submission according to the current industry standards. 

Moreover, in order to maintain a good reputation in the highly competitive industry, healthcare providers should adopt innovative healthcare billing solutions as well as keep themselves updated with the latest trends. Because the patients always give preference to the healthcare facilities that embrace the recent changes immediately.  

Why Claims Get Denied or Rejected?

Claim denials have become a major challenge for medical practitioners. Most of the claims get denied because many medical practices stick to manual methods to process the claims. The chances of errors increases in the orthodox methods as compared to the automatic methods. Generally, the most common reasons for claim denials are:

  • Unverified insurance policies. 
  • Incorrect patient’s information. 
  • Wrong coding. 
  • Incorrect payment credentials. 
  • Duplicated claims. 
  • Late submission of medical claims. 

Tips to Reduce Claim Denials 

Are you looking for innovative solutions to streamline the process of claims submission? Here are the following strategies you can adopt to optimize the healthcare billing services of your medical practice. 

Streamlines Front-Desk Information 

Registration staff plays a significant role in the entire revenue cycle management. They collect the patient’s demographic information, which is required to prepare the medical claims. Because sufficient medical documentation is required when coding and submitting claims. Therefore, you should pay close attention to training your front desk staff. Because it is crucial to streamline the following processes. 

  • Accurate data entry: One of the major causes of claim denials is incorrect patient’s information such as: name, date of birth, gender, phone, email Id ,and insurance information.  

Moreover,  a claim is also denied or rejected when a patient’s health insurance expires. Therefore, your front desk staff should collect the correct patient’s  information. They should ask patients to bring their insurance cards at every visit. 

Because it is possible that you may not be aware of any change in the insurance policy of your patients.  In order to avoid such situations, registration teams should undergo proper training to learn about the use of real-time eligibility tools as well as the education to fill out forms properly. 

Therefore, you should hire highly trained employees to perform this task. Because a single error in this information can lead to claim denials. Which ultimately slows down the healthcare billing services. 

Code it Right 

Medical coding is considered as the backbone of optimized revenue cycle management. Because these codes represent the patient’s diagnosis, treatments, and medical procedures. A medical claim gets denied, If you use the wrong diagnosis codes. Moreover, incorrect medical codes not only minimize the reimbursements but also can land healthcare providers into legal troubles.

So, in order to minimize such errors, medical coders should stop using outdated codebooks. Because the use of outdated coding books either CPT (Current Procedural Terminology), ICD-9 (International Classification of Diseases), or (Healthcare Common Procedure Coding System) HCPCS or superbills will lead to claim denials.  As a result, medical practitioners lose a significant amount of revenue.

Medical coding is undoubtedly a complicated procedure. Therefore, you should hand over this task to only certified and well-experienced medical coders. 

Timely Submission of claims 

Time is the most important aspect of healthcare billing services. Because late submission of claims usually leads to the claim denials. Therefore, you should monitor the performance of your medical billers to make sure that they are submitting error-free claims in a timely manner. Because insurance companies don’t accept the claims which are submitted after the deadline. 

Along with timely submission, it is also crucial that billers have in-depth knowledge about the standard format of the medical claims. Because sometimes, insurance carriers have their own formats and they reject the claims which fail to meet their standard criteria. Medical billers should file error-free medical claims that help you get completely paid for your services. 

Outsource Billing Services 

The in-house management of medical billing services is not an easy task. Because it requires a considerable amount of time and expertise. Medical practitioners don’t have sufficient time to monitor this process efficiently. They may end up with a high percentage of claim denials and revenue loss. If you find yourself in the same situation, you should outsource your medical billing services to a trusted billing company.  

Outsourced billing experts have the extensive industry knowledge to handle revenue cycle management efficiently. They help medical practitioners to drive better outcomes. 

Medcare MSO is an industry-leading medical billing company in the United States. Which has been providing customized healthcare billing services for the past 12 years. Request a free demo to learn more about our value-based services.