How To Handle Denials For Medical Claims

How To Handle Denials For Medical Claims

One of the greatest determining factors for medical offices which make the decision to hire a physicians’ billing service instead of taking care of claims in-house is the concern over denials. Failing to accurately enter codes and other information and process claims efficiently can reduce the cash flow to the office and greatly impact their bottom line. The complexity of the medical billing system and changes to standards that apply to different areas of medical practice make it even more challenging to get claims right the first time and receive timely reimbursements. A professional medical billing service has the trained staff and focus on medical billing practices that will get better results.

For example:

•    Omission or incorrect information identifying the patient. All it takes is a single number or letter left out or written in the wrong order in a name, birth date, social security number or other information, and the claim is very likely to be denied. Verifying all information and submitting to the billing service with each claim will help to eliminate the problem so that every detail is confirmed to be correct before the claim is submitted.

•    Forwarding the insurance information for a patient without confirming that the coverage physicians billing serviceis still active will result in lost time and the need for follow-up billing when coverage has been terminated prior to the time of the claim.

•    Another reason for confirming the coverage prior to providing services to the patient is that the services provided may not be covered under the insured’s policy. Some procedures require authorization or pre-certification prior to being performed that will be denied if the permission to proceed has not been provided.

•    Physician’s offices that handle in-house billing are frequently making the mistake of resubmitting claims after a period of time has passed without payment. A physicians billing service can prevent the problem of resubmitted claims that reset the clock on payments and often lead to denials on claims that would otherwise have been paid.

•    Timely submission of claims is the only way to ensure there is no potential for the amount of time allowed on the claim to expire. Busy offices that fall behind in their billing practices may put small claims aside until they have more time to submit them. The end result is a lot of small claims being denied and the loss of a significant amount of money. A professional billing service will submit claims quickly and efficiently to prevent the buildup of small claims that make up a significant portion of the cash flow.

Human error is often at the core of denials, either from providing the wrong information or by omission. Busy physician’s offices and staff that are dividing their skills between billing and other responsibilities are much more likely to make the simple mistakes that result in claims being denied. Failing to process claims quickly and efficiently cuts down on the cash flow and can prevent many valid claims from ever being paid. An outside physicians billing service will eliminate the mistakes that lead to denials and save your practice time and money in the long run.

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