Insurers deny claims, in fact 9 percent of all claims are denied. These denials take a hit on your revenue each and every year. According to Modern Healthcare, the annual nationwide loss is in excess of $262 billion. Staff that is tasked with the engagement of appealing and processing denied claims to collect on patient bills is a real problem most medical offices face.  

Why do Claims Get Denied?

With all that being said, why do claims get denied in the first place? Well, there are a lot of different reasons a claim might get denied, but here are the most common ones:

  1. EMR & Billing System Issues – System issues happen and resolutions are required. If your computer software is not “communicating” with your billing system and/or EMR, stop and find a resolution.Errors will continue to occur. Completing a “system correction” or detecting an interface error is critical.
  2. Missing information – If a claim has missing or inaccurate information about the patient, the claim could get denied. Both billing and medical staff are responsible for this information. The medical staff should be giving the billing staff as much accurate information as possible, so that the billing staff can fill out an accurate claim.
  3. Inaccurate coding – If documentation is done correctly, it should lead to specific codes for the medical problems. With that being said, if a code is not specific enough or is just inaccurate, the claim could be denied.
  4. Late submission – If a claim comes in after the due date set by the payer, they could be denied even if all the information and codes are correct. 

How to Reduce Denials in Order to Increase Net Sales

Credence Global Solutions provides denials management software that can help reduce these denials and errors significantly which ultimately means an increase to net sales. Their denials management software has various capabilities. Here are a few:

  1. Error processing – Automatic and systematic management of unbillables and rejections
  2. Document management – Automated document loading in to the RCM that allows documents to be used within system workflow, including but not limited to claims and appeals attachments

Appeals workflow – Easily generate a single appeal or appeals in bulk based on payor/denial that include all supporting documentation via document management