Denials management in medical billing is a serious concern that many healthcare organizations face today. If for some reason, an insurance company refuses to honor a claim, then the medical office staff has to rework or appeal the denial or regretfully inform the patient that they will need to resort to other payment options.
In some extreme circumstances, the medical offices may even have to write-off the cost, which the Advisory Board reports to be in the range of 1 to 5% of net patient revenue. Sacrificing that much patient revenue can add up quickly!
While most of these denials can be reworked or appealed to decrease write-offs, the extra effort often puts a strain on staff, as it increases their workload significantly—not to mention the additional costs in labor and workforce!
To give you an idea, here are three helpful strategies that can help your facility avoid medical claim denials.
1. Look for the Root Causes and Address Them
Denials management in medical billing starts with performing a comprehensive analysis of your current systems. The goal is to look for possible inefficiencies that may be contributing to it—if not outright causing it.
A good place to begin looking into is your revenue cycle and paying close attention to the following areas:
- Mistakes in Patient Registrations
- Insufficient Documentation
- Coding and Billing Errors
- Payer Behavior
- Case Management
In performing a complete audit of your systems, it’s possible to see more than a few problems that need addressing. In this case, it’s important to prioritize areas that contribute the most to the overarching issue.
It’s worthwhile to note that addressing any of these issues may require a complete redesign of your procedures. For example, if most cases stem from mistakes in patient registrations, then you may want to look at redesigning the form to make it easier to comprehend.
2. Reform Eligibility Verification Procedure
Eligibility problems form 23.9% of denial cases in the US. Unfortunately for patients and medical groups alike, it’s common to see cases where a patient’s eligibility may be questioned or rejected while on their way to getting a procedure.
This issue typically stems from office staff’s lack of training in understanding a payer’s policies and procedures. To address this, your practice can conduct point-of-service collection training, where these staff members receive additional education about insurance and pre-registration processes from different healthcare payers in the industry.
Through this training, they can answer more complicated questions about insurance and correctly complete eligibility verifications early on in the care process.
3. Increase Registration Data Accuracy
Registration data is crucial to avoid potential errors and delays while processing claims. According to the Advisory Board, as much as 62% of all denials are caused by demographic and technical errors.
Long work hours, the number of claims that need to be processed, and stressful work environments can all contribute to errors that frequently bog down workflows, as this kind of mistake often results in medical claims having to be reworked or appealed.
Medical offices can develop their ways of increasing registration data accuracy for denial management in billing. Some offices create additional layers of verification to ensure that the data they send out is accurate. Another possible strategy is to closely monitor staff members’ performance and report cards as feedback on their registration accuracy.
The Importance of Denials Management
Medical claims can never be eliminated completely. However, pairing the number down to even a few percentages can represent millions of dollars in revenue. While denial management in medical billing is an ongoing process, starting with these three areas is guaranteed to help decrease your denial rates and positively impact your bottom line.
Experienced in Denial Management
Are you looking for an experienced revenue cycle partner that delivers transformational technology that helps eliminate your denials? Credence Global Solutions is a global leader in healthcare end to end services, specializing in Denials Management. Contact us today to find out more about our services!