How Physicians’ Practices can Manage Claims Denial Effectively

How Physicians’ Practices can Manage Claims Denial Effectively

A professional approach is needed to manage claims denial effectively, which is why most physicians are opting to outsource revenue cycle management.

Outsource Strategies International www.outsourcestrategies.com

8596 E. 101st Street, Suite H Tulsa, OK 74133 Phone: 1-800-670-2809

Denials are the bane of every medical practice. Payers have a tendency to deny claims, which is why claims management is a critical element in the revenue cycle management solutions provided by medical billing and coding companies.

Knowing the reasons why claims are denied, following up on unpaid claims, and adopting preventive strategies can reduce your denial rate and help you manage the problem effectively.

Common Reasons for Medical Claim Denial There are many reasons why claims are denied. The common medical billing errors which are easy to correct include:  Incorrect and/or missing patient identifier information  The time limit for claim filing has expired  Coverage terminated  The plan does not cover the procedure  Pre-certification/prior authorization for the medical service was not obtained  No referral on the file  Lack of supporting documentation for claim adjudication Most of the above issues can be avoided with insurance verification services.

Verifying patient benefits before services are provided prevents delays in payment and lost revenue.

However, other types of denials which are related to clinical documentation and medical coding which are more difficult to manage. These include:  The procedure was not medical necessary  Wrong procedure code billed  Missing or invalid CPT or HCPCS codes  Bundling of services in a surgical procedure that is payer-specific and not supported by Medicare rules  Diagnosis code does not agree with enrollee’s age

www.outsourcestrategies.com

Phone: 1-800-670-2809

Preventing/Managing Denials Physicians who outsource medical billing need to work with their medical billing and coding company to prevent/manage denials. Here are some effective denial management strategies:  Prompt follow-up: Acting promptly to correct claims will help you get paid faster. Examine the reasons for denial, correct/add information, and send them back to the payers quickly.  Analyze reasons for denials: This is important for long-term revenue cycle management. Analyzing the reasons for claim rejection is the first step to avoiding issues from being repeated in the future. As your medical billing company to provide you with a denials report.  Focus on controllable denials: As explained earlier, not all denials are easily understood and managed. So focusing on the controllable denials would prove more fruitful.  Appeal for payment: A medical billing service provider can manage this process which involves using an insurer-specific form to make the case. The application

should

be

accompanied

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necessary

documentation.

For

example, if a claim was denied citing lack of medical necessity, physicians can supply literature that supports the medical necessity of the service, an image of the description of the code in question from the CPT manual, or the relevant coverage policy.

Managing claims denial while providing patient care is not easy. That’s why more and more physicians are relying on experienced medical billing and coding companies to handle their revenue cycle issues. Leading companies have expert teams on the job and will perform claim scrubbing to catch errors before claims are submitted. If claims are denied, they will work with physicians to follow-up and negotiate with payers. With a reliable service provider, physicians can expect to minimize denials, maximize reimbursement, and enhance patient care and satisfaction.

www.outsourcestrategies.com

Phone: 1-800-670-2809