Often manual errors, data entry mistakes, and timing concerns can maximize the rate of denials. Therefore, every healthcare practitioner wants to hire an efficient medical billing company to tackle the reimbursement challenges that impact the business cash flow significantly.
Know the difference:
If you want to decrease the denial rate, you must understand the difference between a rejected and a denied claim.
These are the claims received by the payers’ adjudication system. It can’t be resubmitted. It can be appealed after providing additional required documents and doing necessary modifications.
These are the claims that lack basic format necessities, proper coding, and specific data requirements. It can’t be processed as it falls under the ‘’not received’’ category by the payer. It can be resubmitted, after correcting mistakes.
Why do claims get rejected?
Denials can be appealed but can’t be resubmitted. But it could be an expensive method to appeal claims. So, it is a better option to choose an experienced medical billing company that can help you to prevent it in the first place. Following are the reasons for rejections;
- Insufficient information.
- Patient not eligible.
- Untimely filing.
- Service is not covered.
- Improper CPT or ICD-10 codes.
- Duplicate billing.
- Outdated codes.
- Prior authorization required.
- Out of network coverage.
- Problems with modifiers.
How to reduce claim denials?
It is necessary to have a backup process to determine and resolve errors before processing medical claims. Before it leads to more reimbursement losses, it should be fixed on time. Therefore, hiring reliable medical billing agencies can help you in the following ways to get things right at the first time;
Ensure accurate information:
Healthcare practitioners handle non-medical obligations as well as the hassles of medical billing. The foundation of medical billing mistakes starts from the information collection process by the front-end office staff.
Therefore, when you hire a leading medical billing company, expert billing professionals help you ensure the accuracy of the provided information properly. They help you reduce issues in the billing procedures and make sure ID numbers are correct.
In this way, they help you to prevent data entry errors that can delay reimbursement collections and avoid denials. So, before the submission of a claim, they double-check and ensure that all the data is accurate.
Rectify the major reasons for denials:
When administrative staff compiles data for claim adjustment, sometimes the coding errors cause a claim to get denied. Often, they don’t understand the latest legislation of the market and the staff can lack sufficient training.
Therefore, when you hire the right medical billing company, you get access to certified, trained, and professional medical billers/coders. They provide an effective denial management strategy and build an actionable plan. In this way, they help you identify the root cause of the problem and resolve it in a timely manner.
Common denial errors:
Medical billing specialists help you correct all errors that cause denials, some common errors are;
- Duplicate claim.
- Claim not submitted within timely filing guidelines.
- Eligibility expired.
- Demographic errors (e.g., wrong spelling of the patient’s name or wrong date of birth).
- Incorrect modifier.
- Global charges were billed when only the professional or technical component should have been billed.
- Lack of medical necessity.
- No referral/ prior authorization.
- Invalid procedure and/or diagnosis code.
- Payer requires additional information from the patient.
- Incorrect insurer address.
- Wrong insurer billed.
- No supporting documentation.
- Provider not permitted to see the patient under the plan.
- Service not covered.
Streamline claim processing:
When you hire a professional medical billing company, billing experts stay updated with the new transitions of CPT, ICD, and HCPCS codes. They help healthcare professionals to prepare and submit an accurate claim after the charge capture process. They utilize innovative technology and an integrated practice management system to streamline the claim processing significantly.
Moreover, they provide strict follow-up of medical claims to get you reimbursed in a timely manner. They also keep a real-time track of insurance claims. They provide effective claim tracking management strategies that help to stop the claim in tracks if a chance of rejection occurs.
Furthermore, billing professionals utilize practice management solutions to streamline the clean claim submission and denial management processes efficiently. In this way, they automate the entire billing cycle as well as improve the payment collection significantly. In addition to this, they provide peace of mind and help practitioners to reduce their stress by preventing denials/ rejections appropriately.
Efficient billing solutions:
Medical coding and billing errors are troublesome. It is crucial to maintain an optimization between the complicated medical billing and coding procedures. Therefore, when you hire a trusted medical billing company, certified billing specialists help you to optimize all the tasks of the billing and coding system effectively.
Professional billing experts reduce the chance of inappropriate submission of wrong data. Billing specialists use a well-organized EHR (Electronic health record) and EMR (Electronic medical records) system that facilitates the chances of claim acceptance. They reduce your workload and help you automate insurance eligibility verification significantly.
In addition to this, they provide advanced medical billing solutions that help you correct and resubmit denials in a timely manner. They also take a regular follow-up of each medical claim to get you paid promptly.
Furthermore, they ensure no claim gets missed as well as, in-return you face fewer rejections. In this way, they provide a better practice experience, increase reimbursements, improve cash flow, and help you witness the revenue growth of your business remarkably.
Choosing the right medical billing company is essential to improve the financial progress of your medical practice. Therefore, when health professionals hire healthcare billing agencies, they get numerous advantages that help them to enhance the productivity and profitability of their business efficiently. Expert denial management specialists handle all difficulties that lead to claim rejections and improve the revenue cycle.
They rectify the major reasons for denials, streamline claim processing, and provide efficient billing solutions that meet your practice needs effectively. Moreover, they help practitioners to save their precious time and focus on other core competencies of their practice respectively.
Take an Initiative:
Medcare MSO is a HIPAA-compliant medical billing company in the United States. Our dedicated billing experts provide efficient claim denial management services that help practitioners to enhance reimbursement collections significantly. Click here today to reduce claim denials and rejections efficiently!