15 Jul 8 Tips for Avoiding Denials and Improving Claims Reimbursement
The worst thing for a billing specialist to see is the words “CLAIM DENIED.” When claims are denied, it leads to increased work, much frustration, and reduced practice revenue. The American Medical Association found that physician practices spend around $15,000 on phone calls, claims appeals, and investigative work related to billing. Here are 8 tips for avoiding denials and improving claims reimbursement.
- Automate Everything You Possibly Can
Keeping up with different insurance policies, diagnostic codes, and billing procedures is exhausting. However, most billing software providers will automatically update codes and requirements for you. This eliminates research time, allows the billing team to spend more time double-checking claims, and improves reimbursement. Another benefit of automation is that the software system will streamline the process and flag items that should be resolved before claims are submitted. The entire billing team should be aware of how to get reimbursed, so that tracking down information is not necessary.
- Do More Up Front
Before the patient sees the physician, or has a scheduled test or procedure, office staff should take charge of the situation. They must make sure forms are completed accurately, without error, and legibly. In addition. Insurance information should be verified, the patient’s demographics should be updated, and deductible, co-pays, and co-insurance amounts should be collected.
- Be Aware of Changes
The healthcare industry is ever-changing. Even if you have top-notch billing software that flags for inaccuracies, the billing staff and office workers should be familiar with Medicare and other payer standards. This means subscribing to newsletters, attending conferences, and receiving training as necessary.
- Proper Billing Management
For most billing companies and departments, what does not get measured does not get done. Set up policies and procedures to allow your team to check reimbursement request regularly before they are facilitated to payers. The billing staff should have a daily management system in place to allows for minimal denials and maximized reimbursements. In addition, billing management professionals should track the practice’s claim denial rate and set challenging goals for improved performance.
- Investigate all Causes of Denials
The billing staff should investigate the individual causes for claim denials, and formulate a plan to prevent these issues from occurring in the future. Follow-up is necessary to lessen the impact of multiple claim denials. Thousands of dollars are not received each year when the billing staff does not follow-up and investigate causes for denied claims.
- Work on Denials Each Day
The billing company should have professionals that focus on re-working denied claims each day. This should be a standard procedure for one or more billers. When a claim is denied, it does not mean it is permanently denied. The billing specialist should reword, and re-work the claim, re-submit it, and attach documentation if needed.
- Check your Work
Because ICD-10 codes and CPT codes are complex, and billing professionals deal with a multitude of codes and numbers, there is certainly potential for error. The smallest billing mistake cold lead to a denied claim. The billing specialists should check and re-check claims before they are submitted, looking for errors, incorrect data, and missing information.
- Don’t Miss Deadlines
The billing arena is complex and difficult to maneuver. Denials are inevitable in this business. However, you can reduce denial rates by being aware of deadlines. There is no recourse if you miss a deadline, and the money is lost and gone forever. Staff must make sure all claims are submitted in a timely manner, and appeals should be sent in before deadlines. A well-managed billing team can increase the practice’s revenue significantly by managing claim denials and meeting deadlines.
For the top medical billing specialists nationwide, MPMR offers full service revenue cycle management which also includes operations consulting. Call today for a free 30 minute phone consultation!