Rejected medical claims have been plaguing the medical industry for far too long. Studies show that approximately $262 billion worth of medical claims out of $3 trillion in total get denied, with an average of 65% denied claims never returning for a reinspection and never seeing the light of day again. Although, a denied claim can be resubmitted, it is nothing less than an onerous task. With a denied claim, you can stay ensured that once it has acquired a denied rank, it will take minimum 15 days for its reevaluation to get done and an average of $118 of cost. Even then, there is no absolute certainty that it will get approved.
In the health care industry, time is money and while 15 days may only seem like a mere half a month, it will take additional time for the money to hit your bank account, to fuel the growth and sustainability of your practice. Already, there is an average buffer of 30 days between the day you provide a service to the day you get paid, add up to addition 15 days and the waiting period almost becomes frustrating. You could be doing everything right, but what good is it if you are not getting paid for your services?
Currently, there are only a handful of industries that have a lag time of as much as 30 days from the provision of services to getting payed. You have to pay upfront for a service as small as getting Wi-Fi installed at your place and as big as getting a wedding catered, so the point of consideration here is that how can a practice which is already amid a complex reimbursement landscape, afford to have its claims denied? Medical practitioners already have a lot to deal with so if, on top of that, they have to bear the brunt of consequences of rejected claims, then juggling everything simultaneously becomes quite burdensome for them. So, needless to say, it is absolutely dire to pay attention to detail while submitting claims as it’s vital to the survival of a practice.
While some practices choose to hire medical billing services providers and others make amends, it is not an anomaly to protect your claims from getting denied. In fact, there are clear cut strategies that can be followed in order to prevent claim denials all together or at least significantly minimize them to an extent that they don’t become a hindrance for practices to reach a certain level of excellence.
After contemplating the affect a denied or rejected claim can have on the health of a business, we have done our research and based on our own experiences as well, we have crafted ways to minimize billing errors. So, enlisted below we have 4 strategies to help you prevent claim denials.
1. Teach and transmit
By teach and transmit we mean you should educate your staff, from your front desk officers to your medical billing services provider, to follow the practices you have laid out. Start off by devising a strategy and once you have set a brief guideline of how things should go about around the clinic, make sure you transmit that information to the personnel involved. Bear in mind, that regardless of the role (big or small) a staff member plays in your clinic, he has to be informed about the norms they have to follow, since every member has a part that they play whether it is setting up the appointments of a patients or it is providing them with after service care and facilities. Once every one is on the same page, it will be easier to lesson errors and eradicate the ones occurring.
Aside from that, your staff members should additionally be aware of the insurances you accept and the ones you don’t. Let’s say, if one of your ophthalmologists is offering vaccine for some reason, then it is absolutely crucial for your staff to code that service to ask for a reimbursement later.
Bottom line, conversation is key to bring all your staff members on the same page and develop clarity. You will notice a clear difference once you have carried this practice out.
2. Validate the authenticity of insurance before providing the service
One of most common reasons for payments to get denied is because ineligible people use insurance and clinicians end up bearing the brunt of the consequences. A proactive approach to tackle this problem is to verify your patient’s insurance prior to providing him with any services. No matter for how long a patient has been visiting your clinic, you don’t know for sure if he has the same insurance as the last time he payed you a visit, because people switch jobs and their new firm may offer them a contrasting insurance to the one they were using before. So, to keep yourself from coming face to face with awry results, you need to be proactive and incorporate this tip in your billing strategy.
3. Get to know your payers
An important step towards ensuring your claims don’t get denied, is to learn about the payers you have gone onboard with. Most payers often work with 15 – 20 different kinds of insurance plans. These insurance plans have different sets of rules that need to be followed for a successful reimbursement. So be sure to learn about your payer and their rules prior to hiring them.
In addition to that, another thing that can work to your benefit is to know your payers personally. In case of any problems, you can follow up with them to avoid the denial of payments.
So, to summarize, being on the first name basis with your payers can go a long way.
4. Outsource your billing operations to a MBPO
MBPOs have an excellent grasp over medical billing services, and by assigning them such tasks you not only take a huge burden off of your shoulders, but you optimize the cost of your practice.
They manage plenty of claims in just a day which gives them a hold over these tasks and experience which is quite frankly unmatchable by the resources a clinician usually ends up hiring. Not only do MBPOs let you perfect your craft by solely focusing on core operations but they significantly cut down the cost of hiring medical billing resources, paying the rent of the space they occupy and other prices associated with insource billing professionals. Bottomline, outsourcing provides a medical practice with a plethora of benefits.
Although many medical practices struggle to keep up with their payments, it isn’t unheard of to eliminate the problems that cause these bills to get denied in the first place. The above tips have been devised based on our extensive experience in the medical billing industry and research of our professionals. So, if claim denials is the biggest hurdle in your way, then be sure to utilize the tips enlisted above.