How to avoid claim denials & improve reimbursements?

If your healthcare practice is like most, see the words “claim denied” fairly often; that not only leads to frustration and increased work but also reduced revenue for the practice over time.

A study by AMA found that medical practices spend almost $15,000 on the phone calls, follow-ups, and claims appeals associated with reworking claims. This is in addition to the millions of dollars overlooked each and every year because of under-reimbursement.

Medical billing is a very challenging process, but there is no reason your healthcare practice can’t improve its reimbursement rates by minimizing claim denials and working on every claim denial until it is resolved.

Top tips to avoid claim denials 

The following are some of the important tasks in managing denied claims more effectively.

• Incorporate automation everywhere you can

Keeping up with all the diagnostic codes and different insurance policies can be overwhelming, but there are plenty of providers that will automatically help you update codes and requirements. This cuts down on your research time, allowing your billing team to spend more time double-checking claims to ensure they meet every single requirement.

Another benefit of automation is that systems can streamline the documentation process and flag items that need to be resolved before claims are submitted. This implies that your entire team can be aware of what needs to happen to get reimbursed, eliminating the time the billing team needs to spend figuring out what is missing and tracking down the necessary parties.

• Investigate the cause of denials 

If a claim is denied, your billing staff can’t just let it end there. Follow-up is critical to reducing claim denials. It might require some work, however, it’s well worth it to research the cause of procedure denials. You’d be surprised to know millions of dollars are left improperly reimbursed every year because the billing staff didn’t properly investigate denied claims.

• Don’t miss out on deadlines 

Deadlines are a part of the system, and it is significant for healthcare practices to follow the deadlines according to insurance companies’ policies. It is important to pay close attention to the permitted time frame: each insurance carrier has its guidelines. Sometimes you only have up to 30-90 days from the date of service to submit a claim, or it will be denied, and you can’t bill the patient or appeal to the insurance company.

Partner with the experts to prevent claims denials 

It is always better to join hands with a dedicated team of experts that will help you deal with claim denials way before they occur. 

Capline Healthcare Management is a team of highly experienced professionals aiming to offer best-in-class end-to-end revenue cycle management solutions. 

We help healthcare organizations identify the root cause of claim denials which pays off with enhanced claims reimbursement rate.