One of the biggest reasons for medical billing denials is prior authorization. The best practice is to obtain prior authorization before the patient’s visit or performing the procedure. Prior authorization plays a key role in streamlining denied claims management.
Offering medical services that patient insurance does not cover is another primary reason for claim denials. Medical practices should also create a system verifying patients’ eligibility before offering services. Likewise, providing medically unnecessary services causes denials.
To avoid the insurance claim appeal process and ensure clean claim submission, the billing staff should submit claims with complete information. For instance, patient details, insurance details, and coding information must be correct to avoid denials.
Accurate CPT and ICD-10 codes are mandatory to create error-free medical claims. Similarly, medical coders should use correct modifiers to avoid claim denials. Additionally, managing the services that can be bundled or billed separately is essential to prevent payment delays.
To achieve optimal denied claims management, medical practices must file the claim within the time limit. The insurance payer sets the timely filing limit (TFL), and providers must follow it to avoid claim denials.
Here are some actionable steps that can help providers reduce denials and improve reimbursements from payers:
Identifying the most common reasons behind claim denials allows providers to analyze recurring issues in billing and coding, allowing medical practices to address these issues.
Medical practices should check patients’ eligibility before rendering medical services to minimize the chances of denied claims. It saves both the time and resources of healthcare organizations.
The coders and billers at a medical practice should be trained to use accurate CPT codes, perform prior authorization, and check patient insurance eligibility.
Healthcare providers can hire professional medical billing companies that offer denial management services, reducing the hassle of managing denied claims.
Using software solutions to automate the process of using accurate codes, checking eligibility, and correcting patient information reduces manual errors
Utilize advanced solutions for claim scrubbing. It can check the claim before submitting it to the insurance payer. Technology solutions can minimize the mistakes as manual scrubbing is prone to errors.
Claim denial resolution takes time and resources. Thus, it is better to follow the timely filing limit set by the insurance payer to avoid denials.
Without a doubt, tracking claims and finding the root cause of denials are tedious. Having an efficient denied claims management system helps to reduce healthcare reimbursement challenges. Further, managing the denied claims helps providers achieve revenue cycle optimization. So, proactively submitting clean claims can save time and prevent revenue losses. Providers can hire denial management experts to submit error-free claims and help reduce accounts receivable.
