The Secret to Fighting Denials

As a medical practice, there is nothing more frustrating than receiving denials on insurance claims. In order for your practice to grow and thrive it must remain profitable, which means you rely on insurance reimbursements to pay your expenses and your staff. If denials keep occurring, your staff has to spend more time fighting denials and less time on submitting new claims, slowing your revenue cycle.  

Claims Denial Audit

If your practice has been receiving a large number of denials on insurance claims, the first step to fighting these denials is to take a step back and reevaluate the way the claims are being submitted. Look for patterns or recurring errors and oversights by both your staff and the insurance company. Are the denials from the same company each time, or does the insurance company vary? Is your staff commonly making the same mistake? Answering these questions can aid in cleaning up denials and getting you paid faster. We recommend performing a claims denial audit on a monthly or quarterly basis to address any ongoing issues.

How to Conduct a Claims Denial Audit

In order to accurately start fighting denials, the key is to conduct the claims denial audit on a regular basis. To conduct the audit, we recommend you organize the denials by payer explanation of benefit reason and remark codes. Looking at these codes should provide insight into the reason for the denial. From there, organize the codes into groupings based on work flow. For example, there could be a group for patient responsibility, claims that require an appeal, or claims with data issues.

Analyzing the Results

Using this information from the claims denial audit, you should be able to determine where the error was made, and hopefully gain insight on how to correct the error going forward. Conducting the audits in a timely fashion may allow you to uncover a pattern of denials that are costing you reimbursements and get them resubmitted for payment. For example. if the issue is reoccuring with the insurance company, perhaps there is a new rule that has been issued by the insurer in which you are unaware.

Fighting Denials with AMS

At Applied Medical Systems (AMS) we are committed to submitting clean claims, meaning you get paid on the first try. Denials can make up 30% or more of a medical practice’s billing. Translate that into a monetary figure and you are easily talking over a hundred thousand dollars or more in lost profit. For this reason, when you choose to work with AMS for your medical billing services, you can rest comfortably knowing that we are doing more than fighting denials on your behalf, we are avoiding them altogether. Request a free quote today.