All medical practices will face denied claims at some point, as much as we try to avoid them. While these denials can’t be prevented in their entirety, there are ways to reduce them significantly. As long as you follow the right steps, you can prevent denied claims with around a 99% success rate. So, what steps go into preventing medical claim denials? To improve your denial management process, follow these steps.
Claims Tracking
Claims tracking is needed for any medical practice because it helps you stay on top of your denied claims. When you have a good claim tracking process, you’ll be able to see the whole journey of your medical claims, which helps you pinpoint when claims get denied so that you can take swift action to address the problem.
Find Common Causes
Another step that your denial management process should have is figuring out common causes for claim denials. You’ll need the right denial management software to accomplish this because it’s with this software that you’re able to identify these causes. Once you know what’s causing your claim denials, you can prevent those issues from happening in the future and raise your rate of clean medical claims.
Advanced Claim Scrubbing
Reacting effectively to denied claims is an important part of the denial management process, but perhaps something more important is preventing these denials from ever happening. By going through a claim-scrubbing process, you can identify any claims that could potentially be denied if they are submitted.
Claims will typically be denied because there is an error in the code. If you fix these problems while the claim is still making its way towards submission, you can stop a lot of denials from ever popping up.
Automated Insurance Verification
One of the most common reasons a medical claim will be denied is because there is not enough coverage. This problem can occur when patients change the coverage they have and then don’t let their provider know about the change. You can also encounter this issue when coverage expires or won’t cover the services mentioned in the claim.
If you want to improve your denial management process, then it’s crucial for you to verify your patients’ medical coverage and be sure that all the services they receive are covered before you render them. With the right software, this process can be automated, and your front-line staff will be able to verify coverage before the services get rendered so that you can preserve as much of your physicians’ time, and your payments, as possible.
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