Medical practices submit claims to their relevant insurance companies. But it is only when the insurance companies accept these claims, the medical practices earn their revenue. The insurance companies can also deny a claim on one ground or the other. Such medical billing denials eat into the revenues of the medical practices and make them less profitable.
Medical billing denials fall under two categories. They are hard denials and there are soft denials. There is nothing you can do as far as hard denials are concerned. You will have mark them as lost revenue. Soft denials, however, are temporary. You can obtain payment from the insurance provider by sending them additional information.
While it may not be possible for you to bring down the number of denials to zero. There are certain types of denials in medical billing you can easily avoid and improve your revenue. In this blog, we will talk about the most frequent billing problems. We will also touch upon the steps we can take to avoid such denials.
5 Most Common Medical Billing Denials
· Missing Information or Incorrect data
This is one of the most common type of denials in medical billing. Even a single blank field can set you up for denial. Similarly, making typo errors while entering social security information or demographic data can result in medical billing denials.
· Duplicate Billing / Claims
Medical billing denials due what insurance providers term as duplicate billing occur very often. It happens when you repeat the same procedure on the patient on the same week. The insurer then confuses it for a duplicate bill and denies it.
· Bundled Services
Medical billing denials of this kind occur due to same service being part of two different procedures. So, if you have a patient who has availed a service that was a part of another billed service, your insurance provider may deny the claim.
· Filing After The Expiry Of Limit
The time frame to file a claim varies from insurer to insurer. In case of a few insurers, it is just 15 days. However, 90 days-1 year from the day of service is the standard time frame for most insurers.
· Service Not Covered By The Payer
Medical billing denials also happen if the treatment you consider essential for the patient, is not covered under the policy terms provided by the insurance company. Sometimes the diagnosis on the claim form can be the ground for insurance players to deny the claims.
Tips to Prevent Medical Billing Denials
When your team is trained on the best practices in medical billing, you can bring down the rate of claims denials drastically. Here are some helpful points to help you achieve the same:
· Accurate Data Entry Begins in The Front Office
The process of medical billing begins when your front office works takes down the patient information. This is the part where many billing and collection related errors takes place.
To reduce medical billing denials, you must ensure the following:
- Train your front office staff to ensure that the ID numbers are accurate.
- Your front office should double check all numerical data before submitting a claim.
· Accurate Coding
You have to ensure that your staff has a good understanding of the guidelines on medical billing and coding. Many of the codes pertaining to diagnosis and procedures are updated yearly. Thus, you must train your employees on these coding updates. This will reduce your coding related errors and bring down medical billing denials.
· Technology and analytics
To effectively quantify and categorise the denial you need the help of technology and analytics. They will help you in tracking, measuring, and reporting trends according to doctors, departments, procedures, and insurance payers. Such data will help you give you analyse the denial trends, implement the solutions, and keep a record of the progress.
How Do We Assist You In Reducing Medical Billing Denials
As one of the most experienced denial management companies, we have helped several healthcare providers, which include both large institutions and independent practices. Our streamlined workflow enables us to sift through the data meticulously. This helps us to point out the root cause of all your claim denials.
On understanding the issue, we prepare a highly detailed report of all factors leading to medical billing denials. We use this information to introduce process improvements. This invariably brings the denial rate down and optimises your revenue.
To reduce medical billing denials, we regularly make our staff undergo rigorous training schedules. This makes sure that they are up to date with all changes in billing codes and also the change in rules by the third-party insurance payer.
We guarantee you full compliance. All our documentation protocols conform to the rules set by HIPPA and Office of Inspector general compliance. Additionally, our data security standards are very high. We always communicate using firewalls and secure transmission modes (VPNs, SSLs and encryption technique) Thus, you can be sure that your patient data is safe with us.
Who We Are and What Makes Us Industry Experts
This article is written by the experts at MedBillingExperts. We have over 10 years of experience in providing denial management services to healthcare providers. Our services include Revenue Cycle Management, Teleradiology, Medical Billing Services, Medical Transcription, etc.
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