How to Handle Denials in Medical Billing?

Denial management in medical billing is a complex process. Studies suggest that upto 10% of claims submitted by a medical practice are denied and approximately 90% of these denials are preventable and can be reduced to near zero. The best way to start is identifying the reasons for your claim denials and streamlining the medical billing process. 

Claim denials can be due to various reasons such as posting errors, incorrect patient information, inaccurate coding, delay in claim submission, etc. Frequent claim denials are proven to slow down the revenue cycle of a practice and invite additional burden to the providers and their patients. 

This article highlights the best strategies and tips adhering to which a provider can reduce the denials and get paid correctly on time. 

Capture accurate patient information

Incomplete patient information such as social security number or policy number accounts for 61% of denials in medical billing 42% of denial write-offs. The first step to overcome the challenges of claim denials due to inaccurate or incomplete patient information is recording patients’ data into electronic health records in real time. Healthcare providers across the U.S. are experiencing reduced denial rate with the assistance of medical scribes who ease physician burnout as well as maintain the accuracy of clinical documentation. 

Verify the patient eligibility accurately

When a patient visits your practice, make sure to check the patient’s coverage. If the coverage has been terminated or the maximum has already been met, and most importantly, if the patient’s medical insurance plan covers the services your healthcare practice is providing. To maintain accuracy in the eligibility verification process, it is advisable for healthcare providers to outsource their EV process to billing experts who can streamline the process and ensure eligibility verification is accurately done in no time. 

Ensure Accurate Coding

Using an outdated code or entering a wrong code straightaway leads to claim denials. So, making sure your healthcare facility diagnosis list contains the latest version of CPT and ICD-10 codes is of utmost importance. Ensure that your biller and coder have all the expertise and knowledge about coding to reduce your risks of claim denials. Reaching out to the healthcare industry’s best billing and coding service providers can fix this problem as they can ensure your database has the correct and updated diagnostic codes. 

Submit Claims on Time

Submitting a claim after the deadline usually results in denials. Hence, it is important for a healthcare provider to make sure to create an efficient process and the payer’s deadline is met. 

Each and every healthcare facility should have a more well-organized and smooth-running workflow where the staff should be alert about the claim submission deadlines, or an automated tool/software that gives insights to claim filing dates and improves your revenue cycle management. 

Outsource to billing experts

Outsourcing your medical billing to an expert can help a lot. It is one of the smartest and preferred ways to handle claim denials by healthcare providers. It comes with a myriad of benefits such as cost-saving, time-saving, and on-time claim submission, accurate coding, and ultimately, an accelerated cash flow, ensuring you are getting paid timely for the services rendered. Billing specialists can help you develop a denial prevention process throughout the revenue cycle and save your practice’s time and money. 

Learn from your experience 

As a healthcare provider, it is your responsibility to run a smooth workflow at your practice and provide your patients with the maximum care and satisfaction. If you feel the reasons for your claim denials from the past few cycles are common, take the required steps to move past it and discuss it with your staff. Initiating a required step on-time will better your revenue cycle management and smoothen the process overall.