Denied claims are a reality for every medical provider in the United States. While complete elimination of denied claims may not be practical, providers can get close.
Clean claims (claims that are approved after their first submission) up to 99% are possible when you utilize the right strategy, vendor partner, and services. Providers with a higher percentage of clean claims receive payments more quickly and minimize the risk of no payment at all. Implementing a denial management process that works for your practice involves the following five steps.
5 Steps to A Better Denial Management Process:
1) Claims Tracking
Without quality claims tracking, it can be difficult to keep up with denied claims in real-time. Claims tracking software and services are essential to any denial management process as it enables providers to see a claim through its entire journey. If a claim is denied, a provider and their team can immediately address that claim and resubmit it as soon as possible to ensure quick payment. Without claims tracking feature in your denial management software, denied claims slip through the cracks and providers often miss their window to resubmit.
2) Identify Common Causes
An important step to your denial management process is to identify the common causes of denials at your practice. This is accomplished by utilizing quality denial management software offered by a trusted vendor. The software can enable automated processes that quickly identify common causes for denials, and offer solutions for your team. This helps providers understand by their claims are being denied while also monitoring their practice billing process to pinpoint the cause of said issues. By quickly addressing common causes for denials, providers can increase their clean claims.
3) Advanced Claim Scrubbing
While tracking your claims and identifying common causes for denials are both important steps in your denial management approach, providers should try to stop potential denials before their initial submission. This process of identifying potential denials promotes more clean claims and on-time payments. Denied claims are often caused by errors in medical billing codes, where a more relevant code should have been applied. By resolving claims in their tracks, before they have the chance to be rejected, providers can promptly correct the coding issue and try again.
4) Automated Insurance Verification
The second most frequent cause for denied claims is a lack of coverage. A lack of coverage can happen when a patient switches their coverage and forgets to tell their provider, or their coverage expired or does not cover certain services. An important step toward improving your denial management process is to verify coverage for services before those services are rendered. Automated insurance verification is now possible with quality denial management software. Your front-line staff can efficiently verify coverage before services are rendered to protect your physician’s time as well as your payment. Without insurance verification, providers risk important revenue slipping through the cracks.
5) Outsource Your Denial Management Process
The most important step to improving your denials process is to utilize services form a qualified RCM services vendor. By outsourcing your denial management process, providers can accomplish each one of these steps without exhausting their in-house resources. A qualified vendor of denial management software and services allows your practice to improve clean claims up to 99% while still focusing on your patients and avoiding staff burnout. Medical billing experts will track and scrub your claims while providing quality software that allows for efficient and accurate insurance verification and the identification of common denials within your walls.
By partnering with a vendor of denial management services and software, providers can reduce denied claims and positively impact their revenue. To learn more about options that will work for you, click here.