It goes without saying that you will encounter claims denials in your profession. It’s impossible to overstate the value of claim denial tracking. This is due to the fact that your practice’s revenue is what determines its performance, and a major decline in claim denials will favorably impact your practice’s revenue. The lengthy and complicated claim submission process makes it difficult to reduce claim denials. Additionally, it necessitates continuous follow-up, which your employees might not be able to execute because of time and energy limitations. However, it’s still important to get a handle on claim denials, especially if they’re the cause of reduced payments that are losing your practice money.
Payers may reject or decline your claim for a number of different reasons, including incorrect patient data, a false diagnosis or coding, no covered services, and late submission. The entire list is cover in depth below. Knowing the common causes, however, is insufficient for your practice’s proper handling of claim denials.
Typical explanations for denying claims
Medical Billing Denials and Solutions design to assist you in evaluating where your practice is with regard to submitting claims and handling denials. The causes listed below for claim denials are some of the more frequent ones, but they are not required. The only way to identify the most frequent reasons for claim denials at your clinic is through prospective audits.
- Inadequate insurance coverage
- Submitting several duplicate claims
- Late claim filing
- Not enough or sufficiently confirmed medical necessity
- Resubmitting a decided claim
Every practice is different and will have different denial-related issues. In order to assess the state of your practice and address any issues as they arise, it is crucial that your practice engage in active claim denial management with the help of the medical, administrative, and business teams.
Claim denial management is essential for increasing revenue and profits at your practice since it identifies and fixes problems that lead to underpaid claims. Apart from the obvious advantages of audits and fewer denials, the procedure also has advantages in terms of medical billing company compliance issues, bad debt recovery, and a considerable drop in the number of man hours and people dedicated to denials.
What is claim denial management?
Claim denial management is a comprehensive procedure for identifying the difficulties at your practice and focusing on them to successfully resolve these problems. This is a crucial step for your practice since uncovering claims submission-related problems may be just what you need to improve your firm’s revenue cycle management and lower the number of unpaid claims.
The four main steps in claim denial management are Identify, Manage, Monitor, and Prevent. By conducting prospective or compliance audits, your practice can stay on track with claim denial management. Typically, audits are a process carried out to evaluate the quality of patient care provided by a clinic. Although they are great resources for figuring out why patient engagement and retention are declining, they are not the audits that are being discuss here.
Audits of claim denial management are Carrie out on claims that have not yet been submit as well as claims that have previously been paid, rejected, or denied. The new claims that will soon be present are the focus of the prospective audit. These audits serve the objective of having a qualified individual review the claim and look for mistakes including patient data, medical coding, and other issues. This checks for errors that can result in a claim being deny. However, due to the fact that there is a deadline for submitting these claims, it is not feasible for someone to review each and every one that your practice sends.
Retrospective audits concentrate on previous claims that have already been paid or denied in order to determine the cause of the denials. This assists in focusing the frequently occurring theme of claim denials on a small number of distinct causes, such as code compliance or credentialing errors.
What role does Bellmedex play in compliance audits?
Regardless of the task that it is concentrating on, Bellmedex retains the primary objective of the enhanced RCM cycle in mind. Bellmedex offers professional code compliance audits as a remedy to target the problem of claim denials and how that impacts the revenue at your practice. Modern technologies and analytical techniques are use throughout the audits to ensure a flawless analysis of compliance at your clinic.
During these audits, Bellmedex will carefully review all claims, both recent and old, to spot any problem areas and particular problems that are leading to denials. To ensure correct coding and the highest level of accuracy, a large portion of the audit also includes a check for code compliance in your area. Following the identification of the problems, the following step is to verify the accuracy of the modifier usage in order to both repair the claims and make sure that the inaccuracies taken into account in a corrective strategy for future denial prevention.