Strategies to Prevent Medical Billing Claim Denials for Better ROI

Medical Billing Claim denial or rejections are inevitable; however, it can be controlled by taking appropriate steps. Claims denials and rejections are often seen as one, however, there is a significant difference that needs to be understood to ensure they are processed accordingly to benefit maximum reimbursement.

Claim Rejections: Rejected claims are the ones that did not even make it through for the insurance to review, which means they got rejected at the clearinghouse itself or got rejected at the claims adjudications level. These claims did not go through because of various reasons like missed or incorrect details. Typo or formatting error etc. Once these errors are corrected they can be resubmitted for claims processing.

Claim Denials: On the other hand, claim denials means they were denied by your insurance carrier and can mean delayed or lost revenue. These denials are areas of concern for most of the billing companies as they might turn out to be time-consuming and incur additional costs to get them corrected and appealed with insurance with multiple follow-ups. In this article, we will discuss in detail the strategies to prevent Claim denials with better ROI.

How to prevent Medical Billing Claim Denials:

• The common causes of claim denials are incorrect and inaccurate information. Incorrect Patient name, DOB, POS, Insurance details, inaccurate diagnosis and procedure are some common errors that can lead to claim denial
• Using a patient portal to capture patient information and verifying the information helps reduce denials due to incorrect patient details
• Ensure prior authorization requisition is checked and acquired and submitted along with the claim
• Keep a watch on the ongoing updates and changes in the Billing and Coding guidelines and ensure the respective team is aware of the same.
• Regular audits to check on repeated errors and keeping a tab on the same to avoid repetition will greatly help in minimizing claim denials.
• Educating your team with the audit feedbacks and on the billing and coding changes helps curb denial percentage to a greater extend.
• Tracking and analyzing should be part of your day-to-day task to ensure you are closely monitoring the claims processed vs paid and unpaid or pending. This will help you understand if you are on the right track towards your financial goal.
• Having an efficient AR follow up and denial management team is quintessential to ensure every denied claim is reworked and appealed with the turnaround time and followed up until they are fully paid

Taking the necessary steps to keep claim denials at a minimum will result in increased cash flow. Neglecting denials may lead to lost revenue affecting the financial aspect of medical billing services. It is crucial that denials are prevented to ensure the revenue goal is achieved and earn better ROI.

Outsourcing Denial Management and AR Follow up

Outsourcing Denial Management can be the best choice to achieve the target results and financial goals. Offshore outsourcing has proved to yield maximized ROI by handling Denial Management and AR follow-up along with the entire revenue cycle management more efficiently and strategically. With an offshore Medical Billing Company handling your claim denials, you can rest assured that your claims will be appealed on time and followed up until full reimbursement is collected. Offshore outsourcing assures increased cash flow by collecting the lost and delayed revenue and also keeping claim denials at minimal.

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Created on Sep 1st 2021 05:05. Viewed 232 times.

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