How Medical Practices Can Avoid Claim Denial
One in five claims are initially denied. Denials might get worked and refiled but you’re wasting time and money in the process. For most physician offices there will be some claim denials that fall through the cracks and are never corrected and refiled, resulting in the in the loss of much needed revenue.
Below is a list of tips that may help your practice avoid claim denial. Most of these tips to help your practice avoid claim denial seem obvious but it only takes one issue to result in the loss of revenue.
1. Patient demographic information must be accurate in your practice management system. Taking the time to collect and enter correct information on the front end can save unnecessary hassles later on. It only takes a few seconds to verify information when it is initially entered. Correcting the issue after a denial has been received can take a long time to research, costs money to refile, and keeps money out of the bank account for longer than necessary.
2. Insurance verification, including coordination of benefits, should be performed prior to treating patients. This can generally be handled through payor websites, clearinghouses, or sometimes directly through your billing system.
3. Confirm whether prior authorization is needed before rendering services. Take the time to develop practices that make this process accurate and efficient. There is nothing worse than providing a service that will ultimately not be paid no matter how much an account is worked.
4. Ensure that provider documentation is accurate and complete. Audit, train, improve.
5. CPT and diagnosis codes MUST properly reflect documentation. Undercoding costs money. Overcoding costs far more.
6. Utilize the Correct Coding Initiative so that unbundling of services does not occur.
7. File claims in a timely manner to avoid insurance carrier deadlines.
8. Post payments, adjustments and denials in a timely manner for processing of secondary and tertiary claims.
All of these tips are simple yet few offices do all of the above well. Take the time review your billing workflow once or twice a year. You can always make small, and sometimes large, improvements. Never assume that everyone is doing their job exactly like they should!!