Denial, in the medical industry context, is the turndown a patient encounters with a carrier or an insurance company upon his or her request for medical billing. A claim by an individual or their health providers may either be turned down on the basis of denial or rejection.

Neither of these do you crave, as a patient or a health care provider, but the response to your request is apparently not in your hands to decide. Nonetheless, being able to avoid denials is the piece of good news we bring to you in this piece.

A recent analysis estimated that 80% of U.S. medical bills contain errors. This has inescapably significantly contributed to another research that claimed that about 80% denial rates are sometimes encountered in the U.S. In other words, billing errors can foster denials as well as rejections, thereby hindering reimbursement. Well cited right? But medical billing claim denials are way broader.

This and others shall be examined in this piece to help you out in cases of claim denials and rejections. Without any more introduction, let’s walk you through the ways to avoid denials and claim a reimbursement in medical billings.

1. Discover the Root Cause of Denials

We cannot tell a good story of why a claim was denied without knowing the reason behind it. Therefore, to tackle a denial problem, individuals or organizations affected by it must first figure out the reasons as well as the root cause of the previous denials.

In addition, you should also collect data on the causes of the denial and study them.

With the analysis of the root cause, you will be able to know what aspect to focus on while trying to resubmit a claim or work on another.

2. Always Stay Calm and Updated throughout Your Medical Billing Process

You should be abreast of every information regarding medical billings. It doesn’t matter whether you use the software in submitting your requests or not, staying updated helps to know the most recent changes in the system.

Doing this will save you the stress of having to resubmit a claim that was denied due to your ignorance.

Ensure you do not miss out on any Medicare information. A member of your billing team can as well be delegated to attend every billing conference held. Looking into this will save you a lot of future stress and frustration.

3. Deploy Automation Wherever Possible

Due to fatigue and our nature as humans, we cannot always be very correct in handling things, therefore it is ideal that we use programmed devices to handle certain things.

A recent study has shown that this is one way to help avoid denials of claims since it occurs that one reason for this denial is information wrongly inputted and a few other human errors.

There are several medical billing software you can use to help ease and make your requests faster. Some of this software include:

  • Cerner
  • DrChrono
  • RXNT
  • Advanced MD
  • Praxis EMR
  • Therapy Notes
  • NextGen
  • Nextech
  • Cure MD
  • Optum
  • NuemD
  • Kareo; and
  • Practice Suite.

These automation tools will help enhance the efficiency of your organization’s medical billing request. One of the various merits of using software is that it helps to flag and bring common mistakes to the attention of users. In cases where you may mistakenly leave a required field unentered, for instance, the software will notify you.

4. Be Efficient and Consistent in Working Denials

Learn the habit of consistency in your job. A claim once denied is not a claim forever denied. There is always room for corrections to be made. Rather than moving on, find your faults and fix them.

Your team can also learn more effectively by working on denied claims since it means learning from past mistakes – it is one smart way to grow in anything we do.

5. Eligibility Consideration

A study from another view has also shown that it is fundamental for healthcare providers to confirm patients’ eligibility for billing before proceeding to request a claim.

One thing that is not often considered during the enrollment for medical billings is whether a person is eligible for reimbursement or not. Be cautious and take note of this, to avoid future claim denials.

6. Peruse Your Work

Checking if you did fill out each form correctly when you have many numbers to enter on several files can be relatively herculean, but you’ve got to take your time for it. Ensure no file is later realized to have been incorrectly filled.

Considering this can help you reduce the chances of denial by a good percentage. If this means you will be filling out five forms instead of the usual twenty forms daily, then rest assured it is worth it.

7. Manage Your Team Appropriately

Source: medium.com

Learn to manage your team appropriately, with the assumption that not every member of your team, or everyone in the billing department is staying on top of trends.

You can as well teach them to also stay abreast of every updated medical billing information, as you educate them on other things they may be ignorant.

8. Take Deadlines Seriously and Try Your Best Not to Miss Them!

Deadlines are a very essential part of every program that has one, but it is a pity that many take them for granted.

On the otherhand, doing well to be punctual in submitting your claim is another essential tip you want to hold onto. Yes, you will miss out on the whole benefit if you hesitate to conform to this.

In addition, staying updated can help you know when, and this point will teach you to do it on time. If you have a team behind, ensure they are also aware of this, and always fill out forms on time.

Once a deadline has been reached, why do you think you have to submit it again? It simply tells that an initially open room has been closed.

9. Learn to Be Available and Take up Responsibility

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Your reading on this article shows that there are chances you have been affected by a claim denial in the past, so kindly pay attention to this. If after setting back to find out what the problem is that your claim was denied, you realized it is a minor form-filling fault (which is most likely the case), then you’ve got to take responsibility in preparation for the next form.

The responsibility you are to take up has to be enlightening your provider or other billing staff in your team, on the negative impacts of not filling out forms legibly and accurately. You’ve learned here, to teach others that could in some ways affect your medical billing claims.

10. Partner with Experts in the Medical Billing Field

Do you know one way to prevent claim denial from hitting you is to partner with experts in the field? Well, many have claimed this worked out just perfectly in previous years. You can get to learn about the most reputable experts in this field on the web, and work with them.

They can help your healthcare organization reduce the claim denial rate drastically, by highlighting your team on the root cause of any claim denial you have encountered in the past. This option on our list will cost you some money – one reason it is not a commonly practiced act.

Working with experts in medical billing reimbursement claims can be way more effective than the nine other ideas on our list, if you can manage the expenses involved in it – go for it. When you get an expert to work with, they will help you ensure most of the proper steps you should follow, since we have no idea of the exact issue you have with your claim form.

Frequently Asked Question

What Are The Main Differences Between Claim Denial And Claim Rejection?

This is one question that has come to our notice among people inquiring about the given topic. The difference between claim denial and claim rejection is another thing you are likely to be perturbed about.

It is important to firstly, help you realize that there are distinctions between the two terms in question.

While claim denial occurs before a proposed claim is accepted for adjudication, rejection is the negative response that comes after a claim is accepted.

Claim rejection, however, happens while claims are being processed. This may be due to information being wrongly entered. On the other hand, denial sets in when a processed claim is found unpayable. In either case, no reimbursement will be made.

Conclusion

In addition to the just-examined 10 ways to avoid denials and claim reimbursement, there are a few other things we would advise you to look into. To every problem, there is a cause. Understanding what the cause of a problem is, can utter such problems half-solved.

Regarding medical billing denials, a 2013 report from the American Medical Association National Health Insurer disclosed that there are five reasons a claim may be denied. These reasons are buried in replicate claims or services, missing information (letting one or more required fields on the form go blank), billing not being covered by the payer, as well as filing limit expiration.

Taking note of these seemingly insignificant flaws while filling out a claim form, is one smart way to avoid denials and ultimately claim reimbursement.

In conclusion,it is important to remember that denial can lead to increased expenses and decreased reimbursement for medical bills. There are 10 ways to avoid these issues which were already discussed in this article, however, it is important to be proactive in order to increase your chances of being reimbursed properly. Thanks for reading!