As a financial executive for a hospital or health system, you know medical billing denials as constant headaches that negatively affect your organization’s revenue, cash flow and operational efficiency. According to the industry benchmark, the average healthcare organization experiences 2% in medical billing denials. That may not seem like a lot, but when you’re dealing with millions of dollars in claims each month, even a small percentage can amount to big losses. In this blog post, we’ll explore what causes medical billing denials and what you can do to reduce them.
Medical billing services is a very important process for doctors, nurses and other healthcare professionals to ensure that they’re receiving all of their deserved compensation. There are many reasons why patients may receive denials in regards to Medicare or Medicaid claims- it could be because you didn’t submit the correct information at the time of service; your insurance company denied payment on behalf of the patient’s lack thereof (i e “no cherry picking”);or there was simply no record found regarding services rendered by either doctor/nurse who worked together during an encounter which would’ve made them eligible under some type exclusionary policies such as E&M services.
There are a few things you can do as an organization to help reduce the number of medical billing denials.
Let’s start with the first one.
Even One Missing Field Can Cause the Issue
Leaving just one required field blank on a claim form can trigger a denial. Demographic and technical errors, which could be missing modifiers or wrong plan codes prompt 61% of initial medical billing denials leading to account for 42%.
Duplicate claims are among the most common reasons for Medicare Part B claim denials. This is because they can occur when a patient receives multiple treatments or exams from different providers in one visit, and there’s no way to know which treatment was given last – making it appear as if someone had been seen more than once!
When Service adjudicated Happens
This can happen when two services are linked together by a common thread and you have been paid for one but receive another.
Not Covered by Payer
Avoiding medical billing denials for procedures not covered under patients’ current benefit plans can be avoided by checking details in the insurance eligibility response or calling up before you start any work.
Denied medical billing claims are an unfortunate byproduct of the healthcare industry, but they can be prevented with proper prevention practices. By proactively measuring denied claim volumes and causes you will prevent future headaches for your business!
By adding more people to your healthcare claims management team, you won’t be able to prevent or reduce denials unless they know what is important.
The following should always come into play when preventing these types of issues:
Denials should be quantified and classed
In today’s healthcare environment, it is important to track and measure denials by doctor, department or procedure. With technology being an essential part of providing reliable business intelligence for your organization you should not hesitate on investing time into these tools because they will pay off when used correctly!
Create a task force
In order to ensure that the company is prepared for any potential threats, an in-depth analysis and prioritization of denial trends need to take place. This will help determine what resources are needed so solutions can be implemented successfully while also tracking progress throughout this process
Getting the most out of your claims management software
If you want to increase the number of clean claims your company is receiving, then optimize edits in claim management software. Your vendor should provide regular updates and tips on how best for them to work with what’s already been set up by yours or another provider – but make sure all this information reaches an individual level so people know exactly where their data comes from!
Payers can help you reduce errors and increase efficiency
The goal is to work with payers so that they eliminate contract requirements which often lead to denials overturned on appeal. The use of data analytics can help identify trouble spots and support negotiations, making it easier for providers in these areas while also supporting insurance companies who might be negotiating contracts next year or beyond.
When a claim is denied, it can have devastating effects on the patient and provider. It impacts their quality of life as well as costing them time and money to get back into compliance with insurance requirements or satisfy payers rules for payment approval.
As healthcare becomes more specialized in its treatment approaches, there are simply not enough experienced staff members left who know how best handle complicated cases like denials management – especially since regulations change every year! Thats where outsourced revenue cycle management companies come into play by providing expertise around setting medical billing benchmarks; reducing backlogs through expert root cause analysis techniques combined.
It’s no secret that medical billing denials are a major source of frustration for healthcare organizations. But you don’t have to sit idly by and watch your profits dwindle! By understanding the causes behind these pesky denials, you can take actionable steps to reduce them in your organization. Contact us today if you want help implementing an effective strategy to get rid of medical billing denials once and for all!