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How Medical Claim Denials Impact Your Industry

How Medical Claim Denials Impact Your Industry
Here are ways in which medical claim denials can affect your organization.

If you run a medical practice, you’ve undoubtedly come across claim denials at some point. While a denied claim doesn’t seem a big deal at first glance, one rejection can turn into many. As they accumulate, the loss in revenue becomes increasingly apparent. This is why keeping your denial count as low as possible is essential. If you don’t, there can be severe consequences. Here are ways in which medical claim denials can affect your organization.

Lost or Delayed Revenue

While we just finished mentioning this problem, we feel it’s worth mentioning again. When claims are submitted cleanly, your medical practice can bring in revenue promptly. Claim rejections will halt revenue generation, and you’ll need to correct or appeal a claim before receiving the money from it. When you don’t rework a claim, that’s money you leave on the table. Even if you appeal a claim, that money will take longer to reach your practice than if the claim had not been denied. Speaking of appeals, they have an impact on your medical industry.

Spending Money on Denial Appeals

When a medical claim is denied, appealing the claim doesn’t come without a cost. Not only do you miss out on the money from the denied claim itself, but you also need to spend additional money getting that claim appealed to collect the revenue from it. Even after you resend a claim, it could still be denied again if it wasn’t appropriately reworked, and that doesn’t even take into consideration how your practice’s cash flow is impacted.

How Do You Avoid Medical Claim Denials?

If you don’t want your medical claims to get rejected, those claims need to be clean when they’re sent. A medical claim needs to meet three criteria to be considered clean. They have to be free of any mistakes. They should only get filed once, and they shouldn’t get denied for any reason that could’ve been prevented. While this won’t prevent all claims from being denied, you can still generate far more revenue if you know how to keep your claims clean.

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This entry was posted on Friday, February 17th, 2023 at 12:01 pm. Both comments and pings are currently closed.