If you know common mistakes for claim rejections or denials then you can have control over your practice cash flow. In order to have a robust claim submission process, here are a few steps to follow:
Your front office workers, billers, coders, physicians, and other important staff need to continue to learn and discuss rejection issues related to claim denials. You should hold monthly meetings to discuss medical billing and coding issues, customer queries, insurance policies, and any new updates regarding regulations or policies, etc. This would help you facilitate your claim submission process and simplify the claim rejections process.
Frequent communication between the front and back-end office staff helps to prevent the repetition of errors. It is important for the practice to streamline the process that highlights the areas where these issues arise from and the responsible party should be getting a notification to fix the errors, learn and do not repeat the same mistakes. This way they also learn how to document and capture all the necessary information when submitting medical claims.
It is important to prepare and train your staff to submit clean claims. It is necessary to teach them to collect all the important patient information beforehand and fill in claim forms accurately.
You also need to train physicians, doctors, and medical coders to properly select and document the correct medical procedure and diagnostic codes. They need to keep themselves updated with the frequent changes in medical regulations and policies.
Front desk staff needs to ask the patient about the reason for the visit; whether it is a routine checkup or for some important medical procedure. This helps them to schedule appointments with proper duration, time and date.
Despite filing claims with all the necessary information, there would still be instances when your claims are denied. In case that happens regularly, you must take all the necessary steps in order to resolve your denied claim. When insurers return a submitted claim without payment, it must include claim adjustment reason codes and explain why the submitted claim was denied. You would be required to carefully read the code and rectify the problem.
You can create a step-by-step action plan and know about the most common reasons for your claim denials. Document your common reasons and associate them with those denials. Your action plan would then tell you to follow the basic steps in order to avoid those reasons which result in claim denials. This action plan can also serve as your standard operating procedure when you are filing medical claims.
When you are working on a denied claim, always remember to re-submit that claim within the time limit. Also, it is best to prepare supporting documents to support your claim submission requests such as documentation of service, medical necessity documents, copy of claim filing and the explanation of the appropriate selection of the codes.
GreenSense Billing provides medical billing and coding services and produces better outcomes for claim submissions. GreenSense Billing provides an all-in-one solution for medical billing and coding services that helps you maximize your revenue generation and reduce administrative costs. Allow us to speak to you directly and provide you with an offer that you cannot miss. Call us at (218) 203-0510 or email us at [email protected]