How to Prevent and Manage Claim Denials and Rejections

How to Prevent and Manage Claim Denials and Rejections

Insurance claim rejections and denials are one of the biggest challenges that can affect reimbursements for your practice. Errors can prove expensive and can have a significant negative impact on your revenue cycle and bottom line. While you can rework the rejected claims and follow up with the insurance companies, the best solution would be to prevent the rejections and denials, in the first place.

Here are the best ways to prevent and manage claim denials and rejections, whether your practice manages medical billing in-house or outsources it to a medical billing company.

• Identify and analyze denials and rejection trends. Check for the most common reasons, categorize the denials and rejections and plan to fix such issues as early as possible.
• Staff training is extremely important. The billing staff should be well-trained to handle rejections quickly. Provide them training on how to handle denials appropriately.
• Schedule routine audits for data and documentation quality so that problems can be identified and look for patterns before claims are sent to the payer.
• You need to work with payers to discuss or remove contract requirements that may be causing denials.
• Use automated software or professional billing services to make your practice’s claim management efficient. They can also perform analyses to examine the potential denials and address them before claims are submitted.

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