Implement These 6 Steps to Reduce Denials for Your Practice

The workflows you handle every day at your practice be it patient check-in, check-out, the billing process, or revenue cycle management - everything is the same no matter how big or small you are.

Maintaining your revenue flow through efficient billing and claims is important in healthcare practices that stand a chance to pose bigger challenges. Identifying claim denials from both patients and companies to reduce the denials rate and the time between patient service and payment will affect various teams, from the front office staff to the backend team.

Time is the best investment

In 2018, Healthcare Financial Management Association (HFMA) found that out of $3 trillion in total claims submitted, $262 billion were denied, which is $5 million in denials on average.

Here are some of the top causes of high denial rates

Missing information

Sometimes, a mandatory field is left blank on a claim form or patient information is incorrectly entered which can trigger a claim denial. Missing information usually triggers around 60% of medical billing denials.

Duplicate claim or service

A single visit with one provider is submitted twice or more times.

The payer doesn't cover the service

It can't happen that every health insurance plan covers every procedure. So before administering services, verify if all the things will get covered or not.

Improper coding

Coding is required to maintain the fullest level of specificity, considering all identifiers and modifiers. Detailed coding will lower denial rates, particularly in claims systems where denials are easily identified.

The patient is ineligible for services

You need to verify if your patient is covered by insurance. Double checking the insurance information at the first visit is important.

The claim is missing authorizations

If appropriate approval for a service isn't acquired before the patient getting the care, the claim will probably be denied. While presenting a claim, ensure proper authorization was gained for the service and link or attach all appropriate documentation.

For major reasons that will reduce denial rates, 24/7 Medical Services recommends some simple steps that often offer dramatic results. Changing the mindset is one of the major factors. For example - ask your patients "How would you like to pay today?" instead of "Would you like to pay today?"

Best practices to proactively prevent denials

90% of denials can be prevented. So, while implementing changes in the everyday process of practice, some simple operational changes can surely save you both time and money.

Considering you don't know where to begin, you can utilize these techniques to prevent denials:

Educate and communicate

Both internal and external communication is a usual key to the success of any practice, and in the ever-changing healthcare sector, it's imperative. Right from the front office to your medical staff and back office, it's important that your staff understands their responsibility and its role in your success. Everything from patient check-in to clinical care, and collecting patient payments need to be taken care of in order to ensure optimal better revenue outcomes and customer satisfaction.

It’s also necessary that your employees know important elements like what services you do and do not provide, what is covered by the insurance plan of every patient, their co-pays and deductibles, and accurate coding for each service provided. Even a simple flu shot with missing payment adds up.

Verify insurance before the service

Never expect even a long-term patient hasn't experienced an insurance plan change because of job changes or loss, turning 65 and starting Medicare, going on and off Medicaid or commercial insurance because of income, and other factors that influence coverage. Indeed, even similar insurance can have a different group or member ID number, coverage, deductible, or co-pay from year to year. Verify a patient's insurance before each and every visit.

Understand your payers

Most providers accept 15, 20, or more insurance plans. Even identical plans have variations in their features. They also need each provider to enroll in their plan before any reimbursement is completed.

This might be complex with a close relationship with your important payers makes it easier to know the current and ever-changing rules for healthcare necessity.

Proper documentation

With greater complications brought by ICD-10 coding, more specificity is required in your documentation and paperwork. The shorthand notes of previous cases don't cut it if you want to reduce denials and get timely payments. Again, education and communication are necessary.

Leveraging technology

Investing in practice management or a similar system can be expensive and time-consuming. It will be a waste of that investment if your staff doesn't use it to their full advantage. If everyone in your staff is trained properly, there could be fewer chances that important information gets lost in the translation. Remember, hospitals can come across challenges with shifts and departments; due to practice management or such systems.

Some of the services 24/7 Medical Billing Services offer are providing complete IT solutions, implementation, support, and training. We use advanced systems to provide you with review and flag claims before they are sent to the payer.

Avoid mistakes today to prevent them in future

It's always good to prevent mistakes today to avoid them in the future. You can avoid mistakes today, to avoid negligence in patient care. Patient care is important for your healthcare brand and hence, giving proper attention to details will let you win.

Learn more

If you are experiencing a denial rate, a detailed analysis for implementing improvements to your revenue cycle can help you grow. Learn more about preventing denials by getting in touch with 24/7 Medical Services. Contact us info@247medicalbillingservices.com