HOW TO MINIMIZE MEDICLAIM DENIAL AND INCREASE REVENUE?

Medical billing denials are constant headaches. According to a report by American Medical Association, practitioners spend almost $15,000 on reworking claims.
It is a complex maze of healthcare revenue management, and if not handled efficiently, can increase the denial rate impacting your bottom line. Here are some strategies that can help providers recoup lost revenue and improve reimbursement rates promptly. Let’s have a look;

Using automation for claim denials:

A claim gets denied due to minor details and results in loss and written-off revenue. Implementing automated processes and data analytics tools flag potential denials and address them before submission to meet every single requirement.

Keeping up with all the codes and other policy requirements is exhausting. Diagnosis codes to the highest level of specificity can mess up your organization’s cash flow, revenue, and operational efficiency.

The revenue cycle management vendor optimizes claim denial management strategies like interactive reports, dashboards, and claims-level data before submission.

Manage the team to prevent common errors:

From the revenue cycle perspective, train your staff and other employees who impact billing to get the most accurate information starting with patient scheduling to patient registration.

This won’t just provide timely reimbursement but also minimizes the agony in the back end. A report shares, about 8% of the submitted claim is kicking back due to eligibility problems. To verify eligibility and coverage before you schedule a patient can save time and money, as sometimes you need to obtain a referral or prior authorization supported by medical necessity within the timeframe.

Your billing staff should be proactive about the verification and other insurance-related information to enhance the clean-claims rate.

Work on claim denials to recoup reimbursement:

Billing teams usually get busy with new claims that they fail to rework on denied claims due to office backlog or simple oversight. That results in losing crucial healthcare revenue.

When the insurance company denies a claim and the office fails to resubmit for payment it will be permanently rejected for all sorts of reasons.

It’s better to work on claim denials daily with consistent attention to detail to maximize reimbursement. Establishing a standard procedure will help you keep track of claims.

Check your work by identifying root causes of denial:

Neglecting a denied claim can cost your practice millions of dollars over a year. Coming to claim denial rates to zero is inevitable. However, understanding and tracking common denial reasons can improve the process towards a prevention-focused strategy.

Claim rejections are often due to simple administrative errors like digits missing or transposed, misspelt, duplicate claim submission, missing a deadline, services not covered by the insurer, and services previously adjudicated. Instead of a reactive billing process, providers should build a proactive approach towards the revenue cycle to prevent common claim denials.

Diligence scrubbing of claims every time a claim goes out the door to payers. Before you provide a service, check the eligibility 2-3 days before putting things in place.

Establishing a process that ensures reimbursement requests get checked before sending to payers improves performance over time.