Fundamentals to avoid Claims Denials

Fundamentals to avoid Claims Denials

For any practice, reducing the claims denials can put them on the path to increase in reimbursement. Your staff or outsourced billing company often sees the word “claim denied”, which leads to increased work and less revenue for your practice over a time.

American Medical Association study found that many medical practices spend thousands of dollars on the phone calls, to investigate the denied claims, and claim appeals associated with rework on claims. This is adding to the millions of dollars left on the table every year due to less reimbursement. Medical billing is challenging but it does not mean that you cannot improve your reimbursement. Connect with our Medisys Data’s medical billing staff to reduce your claims denials.

Here are some activities to avoid claims denials:

Process Automation

Keeping your staff or outsourced billing company up to date with most current diagnostic codes and different insurance policies can be exhausting, but there are many software solutions that can automatically update codes and requirements. This helps to reduce your team’s research time, and allow them to spend more time checking claims to make sure they meet every single requirement.

Software systems can streamline the documentation process and can prompt upfront about errors that need to be resolved before claims are submitted. Your team can be aware of what needs to do in order to get reimbursed.

Policies and Changes Updates

Your software can flag errors and your billing staff can resolve those issues. But still your billing staff and all in your practice should be familiar with the general changes of Medicare standards and the other payers.

You and your team can be up to date by subscribing to newsletters and attending webinars or conferences so that you can avoid claims denials by staying up to date about healthcare industry updates. Encourage your billing team to circulate important updates with the entire practice so that all of your staff will be aware of updates.

Investigation Reasons

Your practice receives EOB with all required information about claims e.g. how much you received or reason why your claim got denied? If your claims are denied then your outsourced billing staff or your in-house billing staff can’t just let it end there. They need to follow up on a denied claim in order to understand the denied claim reason. This may involve some efforts but they are worth spending time on doing research the reason behind claim denial.

You may be surprised that many dollars are left on the table because of small errors. Let’s start investigating…

Daily Denial Work

Your billing team must be focused on working on new claims on a daily basis. They do not work on denied claims on a daily basis. Make a standard procedure for your team to work on denied claims every single day. Your claims are denied, it does not mean they are permanently denied. Your billers can do necessary changes to claims and get the reimbursement, this can increase your collection.

In every practice increasing reimbursement equals improving revenue of your practice. Without effective billing practices and the constant attention to detail, your practice will experience a high rate of claim denials for all sorts of reasons. A well-managed billing team can single-handedly increase practice revenue by avoiding claims denials.

Are You Ready to Get Billing?

Want to have an error-free billing and coding expert at your work? You are at the right place, what you need now is a partner who can finish out the rest of the work and make the technology and implementation just as simple. That’s what the best medical billing company like Medisys Data Solutions Inc can do. If you’re ready to get started, schedule a meeting with our medical billing manager from filling out enquiry form from our website!

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