For any healthcare practice, the major revenue stream always depends on insurance claims getting cleared swiftly and smoothly. In order to escalate your revenue, your claims processing needs to function with maximum efficiency.
If you’re medical practitioner, you must often wonder why your claims get constantly denied even when you’re submitting accurate information. Insurance companies can be very thorough in clearing out any claims and even minute bits of misleading or doubtful information can lead to total claim denials.
Fortunately, there are several ways in which you can devise a consistent and successful strategy for denial prevention which minimizes your denial rate, leading to a flourishing revenue model.
Here are a few tips you can follow:
Speedy Follow Ups
Review all claims before submitting and make sure to wrap them up within 3 days. If your claims get denied, don’t wait around for any conventional communication with the patient or the insurer. Any incorrect claim should be corrected and submitted for revaluation within one week or sooner. A lot of insurance companies define a specific time window after which any review request will not be valid. The more you wait, the more chances of not getting paid.
Denial Analyzation
While it might seem enough to just correct and submit any wrong claim, there can be a specific set of reasons for constant claim denials. To hash out any common errors, always review your denial reports regularly and look for any specific pattern. It might be a certain coding error or faults in patient details. If you can fix these problems on a root level, you will definitely end up improving your denial rate. You can even maintain an organized denial log which can help you clear a current claim denial by referencing to something similar in the past.
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Optimizing Claim Process
Go back to the basics and evaluate each step of your claim submission process. Try to spot any complacent techniques and rework them in a way to avoid any future problems. Start with reviewing your information gathering process- patient details, demographic information, diagnosis, etc. Always make sure that your medical coders are upto date with the changes in the industry to keep away from any coding errors in your claims. Try to do a daily or a bi-weekly meeting involving all your financial staff to assess your claim denials.
Trained staff
ones that handle all the work related to every part of claim submission process. Be it medical coders or billers, all of them are the focus points of insurance claims. If by mistake, one of your employees commits a minor error due to lack of proper knowledge and inexperience, it might cost you a lot in monetary terms.
Therefore, It is imperative to hire trained staff workers who are skilled and experienced in handling all types of medical claims.
A functioning denial management plan will not only be fruitful in financial terms but will also help you patch up any loose ends in your medical billing and coding systems.
Here at Medphine billing services, we have an industry best claim clearance rate. Our experienced team of coders and billers are adept in handling all aspects of your billing work so you can focus on serving your patients with the best healthcare.
Call us today at 732-419-2907 to know more or visit us at medphine.com now.
