Efficient billing and claims processing are crucial for healthcare organizations. However, they often face significant challenges. Dealing with claim denials from insurance companies and patients is essential to reduce denials and speed up payment.
This effort involves various teams, from the front office staff to the back office team. Despite the time it takes, it’s a worthwhile investment. However, when healthcare practices outsource RCM To the third-party medical billing company in US, They are more likely to have less denied rate as medical billing pays more attention to resolve the eligibility verification related problems in advance, in order to address issues that might hinder the revenue process.
Addressing the high volume of denied claims benefits practices of all sizes, from individual doctors to large groups. To lower your practice’s denial rate, follow these seven steps.
Check Patient Information Up Front
Sometimes, medical groups get so busy or don’t have enough staff to check important patient details. But not checking can lead to big money problems. It’s crucial to explain why reducing claim denials matters. According to the MGMA, 42% of healthcare workers say prior authorization is the main reason for denials.
Teach your team to gather this important info early, like when making appointments or when patients arrive.
Using software tools can make this process easier. It saves time compared to calling providers manually to check each patient’s insurance. But however you do it, make sure to do it every time consistently.
Tell Patients What They Need to Do
Sometimes, patients might not know what they’re supposed to do. To fix this, you can put up signs in the waiting area. You can also give them a form to sign, saying they understand what they need to pay for.
You can also share this info on your website or in your newsletter.
Update Staff Training/Onboarding
In an organization, problems can happen when staff training isn’t consistent or enough. Start by talking to your staff again. Remind them how important it is to give all the right papers to back up the treatments and diagnoses you do. If changes are made in the care, they need to be written down and backed up. This could include codes to explain why patients stayed longer or got a certain treatment.
Make sure your staff learns how to code medical things correctly. They might need some training to learn what’s new. Also, remember these things when you hire new people or bring them on board.
Send Claims on Time
According to MGMA’s research, 7% of healthcare professionals surveyed said that “timely filing” problems were the main reason for denied claims. This is an issue that medical teams can fix easily. Send your claims together and on time. Find out why some are late. Was it a mistake? Are your staff too busy to finish documenting and sending claims on schedule? Identify the main reasons for delays to improve your organization’s response capability.
Contact the Medical Billing Companies For Comprehensive Audit
Consider hiring consultants to conduct an audit. Sometimes, organizations struggle to see their own problems clearly. You might not have the right skills to notice areas needing improvement, like claims and billing. Even if everything seems fine, there might be hidden issues, like not knowing enough about medical codes. Getting consultants to do a medical coding audit could be the solution to help your team improve.
Improve Your Computer Systems
Your computer system might need an update. Medical offices want to avoid risks. Upgrading a computer network and installing new software can cause downtime, which worries managers. But, updating your computers helps your staff work quicker and better. It also provides the newest security features and lets you use special software for managing claim denials.
Make Best Use Of Technology
Instead of using basic software, use specialized software to handle denied claims. This software displays all denied claims and reasons for denial. You can then fix any issues and resubmit the claim immediately.
Learn From Mistakes To Avoid Denial
It’s important to focus on reducing the number of denied claims. This will help improve your organization’s revenue flow.
Having fewer denied claims gives you more flexibility in your budget. You can use this flexibility to hire more staff or upgrade equipment. This benefits both your practice and your patients.
Conclusion
In tough times, medical groups must cut down on denied claims. 69% of healthcare leaders noticed more denied claims in 2021. Before treating patients, check if they have insurance. Remind patients about paying on time to prevent problems. Train and onboard staff better to fix errors causing denied claims. Use special software to manage denials and improve cash flow.
FAQs
What does denial management mean?
Denial management is all about dealing with denied insurance claims. It’s important for medical billing and revenue cycle management (RCM). RCM helps make the financial and administrative parts of healthcare work better.
What does denial management mean in AR calling?
In AR calling, e-care’s Denial Management in Medical Billing process finds and fixes problems causing denials, speeding up the accounts receivables cycle. The team managing denials in medical billing identifies trends between specific payer codes and common denial reasons.
