Medical billing denial is known as “the refusal of an insurance company or carrier to honor a request by an individual (or his provider) to pay for healthcare services obtained from a healthcare professional.” Denials can be real pains and can compromise any revenue your organization brings in. The industry benchmark for medical billing denials, in hospitals, is 2%. Medical practices have denials that range between 5 and 10%.
In some cases, they even get to 15-20%
Fortunately, many medical billing denials can be avoided. It’s unlikely they go away entirely, but even lowering them a portion of a percent has a great impact on organizations. Here’s what you can do to help prevent medical billing claim denials.
- Quantify and categorize your denials through tracking, measuring, and reporting the trends you find with a doctor, department, payer, or procedure. It may be expensive, but investing the time and money into the technologies and analytics necessary for getting reliable business intelligence is well worth it.
- Make sure to create a task force that will analyze your denial trends, and figure out what resources you’ll need to bring about solutions and report the progress you make.
- One of the more common reasons for having a medical billing denial is because there is insufficient patient data, which is the reason for many errors, which ultimately cause denials. To reduce this risk, you’ll want to improve the data quality of your patients at registration so that fewer errors are made.
- When a denial happens, you want to be sure of why it happened. This means you need to find the real reasons for the denial. Instead of just making assumptions and using generic coding explanations, you’ll need to dig deeper and perform root cause analyses to figure out the source of the issue.
- You’ll want to create a denials prevention mindset at all stages of the revenue cycle. This includes everything from patient accounting, case management, coding, contracting, medical records, as well as compliance and patient access.
- Optimize your claims management software to make sure that edits are functioning, up-to-date, and improving the rate of your clean claims. You should be getting regular clean claims rate data from your vendor, as well as any tips you could use to improve it based on your organization.
- You want to make sure you can detect potential medical billing denials so that you can take measures to prevent them from happening. This means you will want to use automated predictive analyses that will help identify any red flags about a denial you might get.
- Work with your payers to lower the contract requirements that usually result in denials being overturned on appeal. Once again, data analytics will help hone in on problem areas and support negotiations.
Contact MedHelp Inc.
For over 20 years, MedHelp, Inc. has helped practices and hospital facilities enhance their cash flow and streamline their front-end-processes and revenue cycles. Our national exposure and experience as Revenue Recovery Specialists allow you ‘Peace of Mind’ when selecting MedHelp, Inc. as your Medical Billing Partner.
At MedHelp, Inc., our experienced medical billing specialists manage your complete practice or facility billing management from beginning to end. Why waste time and money by doing it yourself – Let MedHelp, Inc. take you to the next level!