“Denial – rarely is an effective term to run over especially when you are on the receiving end”. It is a matter of fact that cannot be denied by anyone that claims rejection has a substantial impact on the cash flow of any practice.
In the era of digital innovation, we can’t ignore the significance of denial management, if there is ineffective denial management then it will put the healthcare service provider to bear a heavy loss.
Claim denials and rejections are two prevalent hurdles and used interchangeably which directly affects the doctor’s revenue cycle. So, the finest way to escape from rejections and denials is to submit “clean claims”.
Now denials are becoming a big catastrophe for many health systems and hospitals. Because it will cost health systems up to 2% of their net revenue.
Therefore, healthcare providers need to accomplish all definite standards of health insurance companies to get the reimbursements for the services that are rendered to the patients.
However, the need for effective denial management is necessary to achieve a 100% clean submission rate and increase your practice revenue while improving patient satisfaction.
So, how can the denial management process be improved? Here we look into a few tips that you must go along with denial management of healthcare claims to keep your revenue stream flowing.
Difference Between Claim Denials And Rejections:
It is important to understand the difference between claim denials and claims rejection. Denials usually happen when the healthcare provider processed the claim and then the insurance company repudiated that claim and marked it as denied claims. It is different from claim rejection.
In this case, healthcare providers can’t resubmit these claims. It’s significant to examine why the payer denied the claim so a reexamination request or appeal can be written.
However, if the healthcare service provider has failed in reconsideration appeal will likely result in it being denied as a duplicate claim. This will cost physicians precious time and money as the claim stands unpaid.
On the other hand, claim rejections occur when a claim is submitted to the payer having incorrect or missing information or coding or when a claim doesn’t meet the set standards of insurance companies. In such a case, claims can be resubmitted to the payer after errors have been corrected. These are simple errors that can be corrected very quickly.
Top Reasons For Denials:
The healthcare provider might not comprehend that they are losing potential revenue by not showing enough interest in the denial management process.
Before your practice can discern a way to best keep away from claim denials, it’s critical to recognize a number of the maximum common cause claims are denied.
The most common reasons for denial occur during front-end functions such as patient eligibility, prior authorization, and registration. It means that services that are rendered to patients and submitted for payment aren’t included in the insurance plan under which it is being billed.
According to research below are the percentages that how much these problems can influence your revenue stream and lead towards denials:
Errors with billing and submissions affect 15%
Coding related errors such as procedure codes influence 15%
25% denial occurs due to problems with utilization such as missing or expired code of prior authorization.
Coverage related issues such as errors and omissions in documentation and verification effect 21%
Other Reasons Include:
- Frequently containing errors in pre-authorization or lack of pre-authorization details can cause denials that are recognized after the claim is processed.
- Duplicate claims or late submission for a service – This will happen when a claim is submitted by the same provider multiple times.
- Missing information or incorrect data – Occasionally denials occur due to incorrect data or missing information such as an area that may have been left clean, missing, or wrong social security number also includes inaccurate details of patient and services which are not included in insurance company policy.
- Improper or outdated CPT or ICD-10 codes- Any change in CPT codes or error in ICD-10 code will result in unexpected denials. As a healthcare practicing doctor, you should consider having updates about changes in CPT codes and avoid unnecessary errors to streamline the potential revenue of your practice.
Tips On How To Reduce Denials And Rejections?
Seeing that rejections and denials can cost your practice losing a lot of revenue through the years. Therefore, it’s vital to take measures to manipulate those troubles and also improve your claim rejection and denial rates.
Trained Staff to Improve Patient Data Quality:
It is said before that the first mistake in denial management arises at the front-end tasks (registration desk). In truth, 30 to 40% of denials are commonly caused due to changes occurring in coverage or policies.
However, it is important to train your staff for maintaining accuracy and consistency to avoid any incorrect or missing patient data.
Outsourcing Your Billing and Coding:
Outsource your medical billing and coding issues to healthcare billing companies. Our team at MED-MILES LLC works with you to resolve the issues with rejections and denials. We will take charge of your medical claims, including appropriate billing and coding, tracking to maximize your revenue through our denial management service.
Contact us at +1 888-598-9181 to streamline your billing process and learn more about how we can save your practice time and money so you can focus on your core duties while improving patient satisfaction.
Use Automation Process:
Performing a denial management process manually can increase your denials rate because manual processes cause a human error. Also, it is less transparent and more time-consuming for healthcare providers.
Therefore, the use of EHR (Electronic Health Record) solutions and specialized software can minimize human errors and also increases your level of reimbursements.
Track and Evaluate Trends:
It is important to track and measure the trends in payer rejections and denials. By doing this you will get to know the reason behind your claim denials and where exactly the problem arises. Once you will find where the problem lies it will get much easier for you to fix it.
Work With Well-Trained Medical Billing And Coding Team:
Working with trained medical billing and coding experts will optimize your claim management process and help to reduce claim denials and rejections problems by also decreasing the chances of any human error.
In the end, lowering the risk of error and denials will result in revenue profits- this is what the healthcare providers want the most.