Without a doubt, claim denials are a: a pain in the neck, b: a major source of revenue loss for practitioners, and c: a cause of stress for medical businesses. They do not, however, have to be a common occurrence.
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Here are a few ways you can prevent denials, saving you and your billing staff the time and effort involved in managing them.
Identify What Caused the Denial in the First Place
It’s understandable that in a busy medical office, spending time going through denied claims doesn’t seem feasible, and because of this, the majority of denied claims are not reworked, resulting in billions of dollars in lost revenue annually.
If you want to prevent denials, you have to first understand what causes them. The best way to do this is to dig into your denied claims and figure out what triggered each one. Then determine why it happened. It isn’t important to identify who to blame, but to find what error is being made, where it occurred in your process, and determine how to correct it.
This is time-consuming at first, but well worth the effort. If a mistake is being made and not corrected, that same error is likely to be repeated, resulting in many more unnecessary denials.
Provide Ongoing Training
At Medcare MSO, all our billers are trained before they begin working, but we also provide ongoing training to keep everyone up to date on any changes made by insurers and government payers. Equally importantly, with respect to eliminating avoidable denials, if someone on the team is making an error, there is a good chance someone else has the same misunderstanding about the proper entry. By including error correction in our ongoing training, we are able to make sure everyone on the billing team is aware of the potential pitfall and knows the right way to handle it.
Good training for billers is the first line of prevention for denials by making sure any issues that are found get corrected to prevent future denials.
Education of Billing Leadership Must Stay Current
Possibly the biggest challenge for in-house medical billing is the need for the person in charge to understand all aspects of the process and the details for which each team member is responsible. This makes managing medical billing very challenging for physicians who need to be focused on patient care and overseeing medical staff.
Adding details of updated medical billing codes, modified EHS software, changing payers, patient information management best practices and claim management makes the job too much to handle well.
Successful supervision of medical billing requires being knowledgeable of all the parts of the machine and how they work together. That gives a company dedicated to medical billing a better chance at staying on top of it all.
Denial Prevention Begins with Front-End Staff
While it sounds like a billing department problem, denials actually start at the very beginning of the revenue cycle with the patient connection. Any errors in data collection during registration and preauthorization will result in denials, and there’s nothing the billing department can do if they are given bad information from the start.
Payers do not try to solve any confusions; they just reject the claim. If the claim does make it into processing and there is even the smallest error, such as a misspelled name or mismatched dates, the whole thing gets denied, so ensuring that the front-end is carefully managed is key. Thorough training on your EHR system is an investment that will pay for itself many times over.
Watch for Repeated Denials from the Same Payer
Another thing to look for is where the denials are coming from. When you find that a particular payer is denying your claims, there could be a problem with your contract. Payers have so many different plans and programs that it is very difficult for in-house billers to keep up with all of them. And of course, the billers aren’t the ones who negotiated the contracts, so they may not have been given all the information they need for submissions, particularly when contracts are updated.
Medcare MSO has a proven track record of increasing revenue for our clients, and preventing claim denials is a big part of our success. With a decade of experience in the field, we have developed training programs and billing procedures that eradicate common errors and get every possible claim paid. Give us a call at 800-640-6409 for more information on how we can help your medical business thrive by streamlining processes and increasing medical billing efficiency.