The Top 5 Strategies To Prevent Denials

When you consider that up to 90% of denied claims are easily avoidable, it makes you wonder how many hours or dollars you could have saved if your claims were handled correctly the first time.

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Provider Credentialing

Provider credentialing is a detailed process that reviews a provider’s qualifications and career history including education, training, residency and licenses, as well as any specialty certificates.

Patient Statements

One of the fastest ways to ensure positive cash flow is to improve your process that generates and mails patient statements. Expedite patient payment collections with automated processes.

Accounts Receivables Management & Follow-up

Accounts Receivables (or AR) is money owed to the provider based on the different patient accounts for services rendered. AR is payable by insurance firms and patients.

Denial Management & Appeals

A high percentage of claims put forth by patients or providers are denied by insurance companies due to incomplete claim forms, wrong diagnosis code, incorrect modifiers, and more.

Charge Entry

Charge entry process is the most critical and important feature of the medical billing cycle where the claims are actually created.

Medical Coding

Medical categorization or medical coding is the method of converting medical diagnoses reports and dealings into a collective list of assigned medical code numbering.

Claims Scrubbing & Submission

The number of denied or rejected claims is reduced drastically when you incorporate successful claims scrubbing that detects and eliminates errors in billing codes before submission.

Insurance Eligibility Verification

Insurance eligibility verification is an important process wherein a provider’s practice or healthcare facility checks into a patient’s insurance coverage to learn what services or treatment will be covered by insurance in order to offer better consultation and care.

Patient Registration

Your registration process will capture your patients’ information, including insurance information. Ensuring an optimized process ensure you get paid faster for services rendered.

When you consider that up to 90% of denied claims are easily avoidable, it makes you wonder how many hours or dollars you could have saved if your claims were handled correctly the first time.

If your practice or lab is currently facing a high percentage of denied claims, you need to examine the processes and practices that are currently in place to find weak points in your strategy. (Luckily, our data shows that up to 67% of denied claims can be recovered, so be sure that you include an aggressive denial follow-up process in your overall denial management plan.)

Before handling your next claim, make sure you add these strategies to your plan:

#1 Examine Past Denials

Use your available data to examine past denials. Search for recurring reasons for denials. A few common areas to analyze would be:

  • Patient registration and access
  • Insufficient documentation
  • Coding and billing errors
  • Payer behavior and protocol
  • Utilization/case management

#2 Create Best Practices

After you’ve examined the causes for past denials, create a document that focuses on best practices concerning the problem areas. Be sure to train your staff on your chosen best practices to reduce the chance of the same mistake recurring. For example, if errors in medical coding are the main reason your claims are denied, you should create a sheet with best practices and tips for proper coding.  

#3 Double Check Referrals & Authorizations

Because authorizations issues account for up to 18.2% of claim denials, it’s vital that you train your staff to double check referrals and authorizations. It’s also advantageous to examine your past denied claims due to authorization issues and analyze the data to find the root cause. Was the authorization date expired? Was authorization ever obtained, or was it obtained for the wrong procedure? Knowing the root cause will help you address the underlying problem, allowing you to create best practices and tips for referrals and authorizations so claims are approved the first time around.

#4 Ongoing Revenue Cycle Management (RCM) Analysis  

The key to ensuring that you’ve got a good offense for denial prevention is to examine and optimize your RCM consistently. It’s important to work actively towards improving your RCM’s speed, accuracy, and efficiency. Consistent examination of your RCM will ensure that problems get found quickly so new processes can be put into place to maximize revenue.

As a best practice, we recommend holding scheduled monthly meetings to review the prior month’s key performance indicators such as denial rate, days to collect, outstanding accounts receivable, and more.  

#5 Hire An Outsourcing Company

An outsourcing company like Plutus Health can help you create a custom RCM strategy that includes denial management.

Our outsourcing services free up your staffs’ time to concentrate on clinical operations and customer service. And because we  offer the option to work with your existing software, there’s no interruption in your process or cash flow.

Our dedicated team is ready to help you create a revenue growth action plan that includes successful denial management. Contact us to start maximizing your revenue today.

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