A medical practice should always be looking for continuous improvements in their denial management processes. It serves as a major part of a healthcare organization because medical claims are denied all the time for various reasons. Since we want your healthcare organization to succeed in every way possible, we have compiled a brief list of some of the best ways to improve and handle claim denials in the healthcare industry today.
Uncover Why Exactly Claims Are Being Denied
In order to improve your denial management process, your first order of business should be to pinpoint why claims are being denied. By doing so, it will maximize your practice’s revenue collection. When a claim is filed incorrectly, it is almost always going to be rejected. In order to combat this from happening over and over again, it is worth educating your front-end staff and monitoring your claims submissions on an ongoing basis. This can be done by delegating members of staff to handle these tasks.
To improve denial rates and recover leaked revenue, you must first understand the most common causes of denials:
- Registration Errors and Eligibility
- Invalid or Missing Claim Data
- Absence of Preauthorization
- Medical Coding Errors
- Poor or Insufficient Documentation
- Lack of Medical Necessity
- Untimely Filing
Log Your Claim Denials
How can you possibly keep track of all your claim denials without having some sort of a log sheet? It is an integral part of your denial management process. Today, since we have technology at our fingertips, we have access to electronic logs that you can use for your claims denial management. Your records should include key pieces of information like date of service, individual claim numbers, payer correspondence and documentation, and the medical code. Also, by having an up-to-date record of claims denials from insurance companies, you can use it to identify errors so your team can learn from them.
File Appeals As Soon As Possible
A successful denial management process will allow a practice to handle claims appropriately and resubmit the claim quickly. It should only take a few days to be able to file appeals with a rejected claim. The quicker you do this, the better off your practice will be. You will be able to do so with the help of your tracking system that will alert you when a claim is sent back from an insurance company.
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