Reducing claim denials is a top goal of any competent billing company. For healthcare providers, credentialing is crucial to achieving this goal. Whenever a provider accepts a health professional, they need to vet them extensively to ensure quality. Additionally, giving insurance companies inaccurate information can frequently lead to denials.
So how can you avoid credentialing-related denials and maximize your practice’s income? Here are a few critical practices to get started.
Credentialing mistakes typically come in two places: when hiring a provider and when contacting an insurance company for payment validation.
A common misstep in the first category is rushing the credentialing process. Once an organization has established standards, it must reinforce those standards consistently. However, doing so requires time. A new physician's history needs reviewing, references need contacting, and records need accurate filing. Missing these steps frequently leads to denials down the road.
The second type, insurance credentialing denials, often can be circumvented by avoiding the communication delays between provider and insurer. If you are a large practice, consider taking responsibility for your company's own credentialing. This change eliminates costly time exchanging files and requesting information. However, doing so will give your payers the ability to audit your company.
Some medical certifications need revalidation. Insurance payers have strict standards in terms of when certification is acceptable — and when it becomes useless. While some revalidation is legally required, different organizations have unique requirements. For example, your physician’s paperwork may be correct for Medicare, but Anthem required a new document a week ago.
To avoid confusion, keep a clear list of what companies need updates and when. Distinguish between types of institutions, such as state-run or private. Many federally run health programs have similar standards.
When an insurance payer finds a credential mistake, the company may take a long time to review the error. This process can harm an active practitioner. If one company finds a detail that needs review, then it’s likely that other companies will do the same. Failing to identify and correct this detail can significantly increase the waiting period before payment verification.
When an insurance company takes longer than expected to review a claim, contact them. Explain that you are eager to fix the issue and want to know what is causing the holdup. Even if the cause of the delay is technically no problem, the fact that it wasted so much time suggests a change is necessary.
Failing to predict how long a provider will take to be approved is a critical error many practices commit. Remember, insurance payers frequently have high workloads, and your practice may be a low priority. Give yourself at least 90 days from the request date to the expected time of approval.
Avoid underestimating how much time your staff will take to complete a task. And make sure you have experienced personnel to lead your billing team. These people are much more likely to give an accurate, experience-driven assessment of work and wait time.
If your service is experiencing multiple denials, immediate action is necessary. Often, t is helpful to create a report detailing common errors. Record what the underlying problems are and narrow down consistent patterns. Once you’ve identified these patterns, work towards eliminating the errors that created the denials.
If insurance payers consistently deny your verification requests, your practice's health is in trouble. Consider hiring a billing and collections service to verify your credentialing. This option works great for smaller companies hoping to speed up the collection process or for larger companies hoping to avoid costly audits.
At Plutus Health, our highly knowledgeable team helps medical practices streamline their revenue inflow. We’re dedicated to preventing denials from small clinics to large physician offices. Our team understand denials specific to your location, making identification, analysis, and prevention of denials much easier.
1. Avoid rushing through credentialing and failing to record critical information.
2. Update your documents to match every insurance company’s standards.
3. Keep realistic expectations for how long processes will take and plan accordingly.
4. Narrow down denials to find what errors cause them.
5. Contact an insurance provider for any delay to get a head start on problems.
6. Hire a professional billing service to streamline processes and help avoid costly errors.
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