Medical claims constitute a large aspect of the success of your business. They can also be a significant reason for revenue losses if claims are rejected. Denials can negatively impact revenues, cash flow, and efficiency. Based on the Medical Billing Solutions Denials for practices of physicians range from 5-10 percent.
To ensure that your revenue flows are consistent and to decrease the number of denials, you must have the correct denial management strategy. While reaching ZERO denials is nearly impossible, it’s possible to achieve the 1% mark when you have a sound plan in place. The professional medical billing process and the coding. One thing we are aware of well is handling denials. Before Medcare MSO, look at ways to help your business manage denials. Let’s look at the two kinds of denials as well as the five most frequent reasons for denials.
- 1 Medical Billing Solutions
- 2 7 Strategies for Effective Claim Denial Management
Medical Billing Solutions
Two Types of Denials
- A denial that is hard to accept is indefinite. It is not reversible or rectifiable, and it’s lost revenue.
- A soft denial” is temporary. It may be paid when the claim is rectified and/or includes additional information.
The Top 5 Reasons for Denials
Based on the Medical Billing Solutions The following are the top five causes for denial of claims:
- Incorrect information
- Duplicate claims
- Service already completed and settled
- Ineligible service under the terms of a health plan
- The deadline was missed.
7 Strategies for Effective Claim Denial Management
Coronis provides the following seven methods that your practice can implement to improve the management of denials:
Patient Data Quality
Make sure you register correctly and you’ll have a lot of headaches eliminated before they begin.
One of the main reasons for denials is the absence of a deadline. A system that is efficient in its workflow will ensure that all necessary claims and documents are filed within the deadline.
Why Was a Claim Denied?
What was the primary motivation behind the refusal? Did the patient have a clear understanding of the procedure and did he/she adhere to the procedure? Do you and your employees ignore a rule or are you not aware of any recent or unexpected change? It’s simple to figure out why the claim was rejected, but it could be a grave error to make that assumption. If you can pinpoint the source of the problem, it is possible to be ready and anticipate possible denials.
Make it easier to quantify denials by using automated claims management system software.
It’s easy to get lost in the shuffle of denial claims and let them accumulate. This makes tracking them more challenging and leads to a loss of revenue and profits. When you invest in software that can automate the process, you’ll be in a position to streamline. This helps in tracking claims, as well as resubmitted requests, and can help reduce revenue loss.
With automated and streamlined processes, this workflow can be made more efficient. Therefore, claims that are denied are analyzed, rectified, and then resubmitted quickly. This decreases the chance of being behind and helps increase more frequent collections, helping to maintain profit.
Follow the Progress
From beginning to end From start to finish, you should be at the forefront of your practice throughout the entire process. By automating and conducting regular analyses, you will be able to pinpoint issues quickly by keeping track of the exact location of each claim. It also aids in understanding how common issues arise.
There are usually at the very least two or three commonalities that are inherent in denials. A regular analysis can help you identify these patterns and pinpoint the root cause, which will help you be more prepared to ward off threats to revenue. For more information on Medcare Medical Billing Services as well as our offerings, call +1 800 640 6409, or go to website medcaremso.com.