Collecting data regarding your claim rejections can certainly help you recognize the necessary patterns and opportunities so that you can further prevent future claim denials. Even the best performing medical billing companies can have claim rejections and denials. According to some sources, 65% of rejected claims are never re-submitted for resolution as it costs in terms of money and time. The problem with denied claims is that if you don’t research, correct and re-submit the denied claim within the appropriate timelines required by the insurance payer; chances are that you may never get paid. Here are five easy steps to help you lower your claim rejections and increase your revenue.
It is important to understand the reasons behind claim rejections. Front Desk must ensure to take proactive and diligent steps to prevent mistakes which can lead to claim denials. Most common medical claim rejections happen due to incorrect patient registration information. Failing to collect accurate patient registration information and then verifying it for insurance coverage would eventually lead to a claim denial. This also happens due to data entry errors, patient’s ineligibility for medical claim and non-covered medical services. Therefore it is necessary for the staff to prevent patient registration information related errors. They need to collect and enter 100% accurate patient information before and during the registration process.
In order to avoid claim denials based on failing to obtain authorization and clearance for a certain procedure or medical service, it is important to obtain authorization prior to any procedure. Hospitals or medical billing companies can use a pre-defined software tool to help expedite authorization status before patients are scheduled for any procedure. Staff can also obtain on-site approvals, Nowadays, hospitals and clinics have a predefined online system tool to obtain authorizations on the spot as certain medical procedures require authorization before they are performed.
There is no doubt that medical coding is complicated and a complex procedure. As there are many medical code combinations, it may not be surprising to see claim denials due to coding errors. Medical coding must be done accurately and by professional medical coders who are more capable and experienced to handle all sorts of medical coding. Common coding errors include:
Any appropriate medical needs for an item or service must be clearly documented in the patient’s medical record, it helps proving the Medical necessity for any item of service which was necessary for the diagnosis or treatment. Services such as these must be documented and provided for the diagnosis or treatment of patient’s condition like illness, disease or injury. It is also in accordance with the current standards of good medical practice and can be safely provided to the patient.
It is important to avoid common billing and claim filing errors such as missing information, specific dates, date of accident or date of emergency etc. It is always important to fill out the most common pieces of information, even the slightest details. To avoid such common billing and filing errors, it is crucial that the front desk registration staff diligently fills out all the required information on claim forms and then double check all the details before the claim is submitted.
Some of these quality checks can improve the entire claim submission process and gets you maximum reimbursements. With GreenSense Billing, you can just as easily improve your claim submissions and resolutions. You can choose to train your staff further or partner up with GreenSense Billing, either way these tips help you run an efficient and productive practice.