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5 Reasons for Insurance Claim Denials & How RCM Services Can Help

Providers everywhere are battling revenue impacting denials and searching for ways to minimize them, whenever possible.

Insurance claim denials leave a provider more dependent on patient payments than payer reimbursements. By reducing denials and increasing clean claims, providers can optimize timely reimbursements.

Common Reasons for Insurance Claim Denials:

Below are some of the most common causes of insurance claim denials experienced by providers across the country. These causes for insurance claim denials are avoidable when the right resources and tools are utilized by an organization.

Failure to Meet Pre-authorization requirements

Some insurance providers require pre-authorization for certain services before they are rendered to the patient. If the provider fails to meet these pre-authorization requirements, it could lead to an insurance claim denial.

Error in Medical Billing Code

With medical billing codes constantly changing and adjusting to new services and new technology, another common cause for insurance claim denials is an error in medical billing codes at the time the claim is filed.

Claim Was Filed at the Wrong Time

Each insurance company has a different billing cycle. If a provider files a claim at the wrong time in the payers billing cycle, this could lead to an insurance claim denial.

Out of Network Provider

Insurance providers change and adjust their network on a regular basis. If a provider falls out of the network at any point, their claim may be denied.

An RCM Services Vendor Can Help:

The best solution for avoiding these common causes for insurance claim denials is to utilize an RCM services partner. Doing so can increase your clean claims up to 99%, minimizing insurance claim denials and optimizing your payer reimbursements. The following are some of the ways an RCM services partner can help your organization avoid insurance claim denials.

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Trained Billing Experts

A quality RCM services partner is fully staffed with a team of fully trained billing experts. Working diligently to stay up to date on any and all adjustments to medical billing codes, your RCM services partner ensures your claims are always coded correctly.

They also stay trained and up to date on payer billing cycles, optimizing your claims process so that you are always filing at the correct time in the month, maximizing your reimbursements.

Claim Scrubbing and Tracking

Your RCM services partner should also utilize claims scrubbing to comb through each one of your claims and ensure each one is filed correctly, each and every time. Claims scrubbing involves your RCM services vendor double-checking the work of your team, ensuring no detail goes unseen and every claim is submitted correctly the first time.

Following the claim scrubbing process is claim tracking. Once your claim is filed, your RCM services vendor should follow it all the way through to reimbursement, making sure your practice is optimizing payments. Should a claim be denied, your RCM service partner should notice immediately, correcting any errors and resubmitting it as soon as possible.

Learn More About Real-Time Claim Submission 

Automatic Eligibility Verification

Lastly, your RCM services partner should offer your practice quality technology that enables your practice to avoid any pre-authorization mistakes or lack of eligibility among patients. Automatic insurance verification from your RCM services partner makes sure your patients are covered prior to receiving services so that you are always protected.

To learn more about an RCM services partner that can help you avoid costly insurance claim denials, click here.

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