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Denial Management – Are you watching your denials? Take these preventive measures to maximize your reimbursements

Health care services have been made financially accessible for most people due to the implementation of medical insurance. As much as it is beneficial for patients, the process of insurance claiming and reimbursement for the services provided by a health care center or medical practice can be tedious and further complicated by frequent claim denials. A claim denial is when your health insurance refuses to pay the claim submitted. This will affect the financial health of your practice due to unpaid services and decrease your revenue.

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Reasons for Claim Denials

Some common reasons for claim denials are:

Incorrect coding of service
Incorrect or missing information
Claim not filed on time
Non covered services
Insufficient medical necessity
Provider network issues
Pre-authorization requirement
Duplicate claim
No elgibility verification

Are You Watching Your Denials?

Claim denials lead to a decrease in revenue, hence it is very important to develop a strategic process to identify and resolve the reasons for medical claim denial and implement preventive measures over denials with regular reporting and management updates. This helps to prevent similar claim denials in the future.

Preventive Measures To Decrease Claim Denials And Increase Your Reimbursements

Denial Management Team

Setting up a team of people solely responsible for denial management helps to identify and resolve claim denial much more efficiently. This team can be assigned to immediately process the denied claim, resolve the issue, and submit an appeal and ensure the reimbursement is received. Their main goal would be to investigate each denial systematically to identify the root cause and build a process to reduce denials in the future. Educating the team on recurrent types of denials plays a key role in addressing the issues from stemming up.

Identiy the Causes

While attending the denial claims, the cause of denial can be identified and sorted into groups. The cause can be missing information, incorrect billing, non-covered services, and so on that is usually mentioned by the insurer when sending the denied claim. These causes should then be communicated with the related department and provide necessary education and training to avoid claim denial in the future.

Immediate Attention to a Denied Cliam

The process of re-editing and appeal submission is a complicated process and if not attended immediately can get missed or not get filed for an appeal on time. This causes a loss of reimbursement and affects the overall revenue. Hence, to avoid this, they must be immediately addressed.

ALSO READ – Importance of Timely Collection of Patient Balances on Practice Financials

Set Up a Checklist

Errors due to missing information is one of the main causes of claim denial. The process of re-editing and resubmission of a denied claim is time-consuming and costly. Hence to prevent this cash outflow due to claim denial, you can set up a checklist to be marked off before submitting a claim. This should be incorporated as a mandatory step that can help in increasing your reimbursements.

Monitoring Denial Management

A record of denials with dates received and appealed, reason, and compensation status helps to monitor how effective your denial management team is and also which department needs attention and orientation to decrease errors during claim submission.

Using representative charts to elaborate the net effect on your revenue due to claim denials can help you identify the magnitude of impact on the finances of your practice. You should also seek facts and implement changes throughout every step of the revenue cycle.

Denial Prevention

Implementing preventive measures in order to avoid the time-consuming and costly process of claim denial management is a much more efficient approach for increasing your reimbursements. Your denial management team should identify and categorize the most commonly encountered denial reasons and can address them to concerned departments.

These preventive measures include:

Training the front office staff for accurate coding and billing
Accurate and complete patient information and medical records
Timely filling of claims
Stay updated on the insurance claim process changes
Using electronic medical recording system to gain easy access to information while filling insurance cliams
Verify insurance and eligibility before providing service
Monitor and analyze your revenue generation and denial rates regularly

Outsourcing

Outsourcing is also an effective option for claim denial management. Error-free claim submissions are handled by medical billing experts that help in the timely collection of reimbursements. In case of claim denial, they can analyze the reason and resubmit the claim without any delay.

Key Takeaway

Most causes of claim denial are due to human errors in the claims submission process and are usually preventable. Analyzing the most frequent errors, then re-educating and training the concerned department can minimize claims denials.

Denial management includes the identification of the cause of denial, re-editing, and timely appeal filing to collect the reimbursement of services provided. Denial management also includes monitoring the reasons for claim denial and implementing preventive measures to avoid future claim denials that can be beneficial for the financial health of a practice. Practolytics has a dedicated team of experienced coders and billers that works on addressing all the denials in a timely manner to ensure no money is missed out due to the denials. Get in touch with our denial management experts and we will walk you through the entire process.