Managing claim denials is
important for the ongoing success of healthcare organizations. Establishing an
effective denial management process can significantly increase your revenue
cycle and reduce your number of future denials. In 2012 National Health Insurer
Report Card exposes that insurers deny up to 5% of claims on the first
compliance. Even the best-performing medical practices have denials of 5%,
according to the 2012 Performance and Practices of Effective Medical Groups
report. To avoid losing money on the
table, you are required taking steps to improve your medical billing process
and reduce your denials.
Follow these four strategies to denial management—identify, manage, monitor and avoid.
Retain your Denial Management Process
Losing track of denied claims is
like leaving money from your back pocket. Once, it's frustrating. But as it
keeps happening, you'll have a serious problem on your hands, as those denied
claims have a method of piling up over time. If you don't have an organized
system in place to retain track of your denials, you won't even know when
they're missing in the first place.
Determine Patient Eligibility
Train your staff to gather
pertinent info about every patient’s health insurance coverage and benefits
eligibility. They need to remember to ask the patient about variations in
insurance coverage, too. Your practice management system should have the
ability to verify eligibility and advantages.
Reduce Coding Errors
Coding errors will likely lead to
more denials. Take positive steps to reduce coding errors. Identify services
usually provided by your practice, and then seek expert advice on how to code
those services. Train your doctors how to document properly and select the
correct codes. Use info technology (i.e., code correct software) to confirm the
accuracy of the codes, either when the codes are selected.
Determine Medical Necessity
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