How to prevent Claim denials from Payers?
Do you know that the payers reject
up to 10% of all the claims submitted in healthcare practice? However, approximately
90% of the claims that are denied are preventable. The rules and regulations
for the claim submission can also vary based on the payer and the patient
conditions, and the services offered. But even the most meticulous medical billers experience claim
denials.
Is
denial management a significant issue?
Once you are aware of the most
common denial reasons, you can certainly avoid them and reduce the number of
claim denials. Here are the common ways by which you can prevent the claim
denials:
1. Always
verify the eligibility and the insurance
Around 24% of the denials happen
because of ineligibility. Just like people change their jobs, people change
their insurance plans as well. So it is always important to check the coverage
of the patient before rendering any service. Also, check- is their coverage still
active, do they have the benefits left in their coverage, or do their plans
cover your medical services?
You also have to ensure that your medical
billing team
employees are aware of what plans you accept and how to interpret the insurance
policies. They must be updated about the policy and the regulation changes to
be comfortable discussing any coverage issues with the existing patients.
2. Collect
complete and accurate patient information
If you leave one blank field on the
claims form, it can result in a denial. Incomplete patient information,
incorrect plan code, missing social security number, etc., account for 61% of
the medical bill denials. Of these denials, around 42% of the denials are
complete write-offs.
Usually, the most common data
missed on the medical billing claims form include the accident date
and the medical emergency date, the date of onset for a disease. So it is
always wise to double-check:
·
Patient
name
·
Date
of birth
·
Insurance
payer
·
Policy
number and other details
3. Always
verify the authorizations and the referrals along with the medical
documentation
18% of the denials happen because
of issues related to pre-certifications and authorizations. While you might
take a while to learn about which accounts for medical necessity services and
which require prior authorizations and referrals. It is also true that prior
authorization doesn't always guarantee reimbursements. The claims must also
have the medical necessity documentation filed within the given deadlines and
have the note of referral or authorization. To ensure that you are within the
boundaries of the medical necessity, only perform a procedure when there is a
medical reason. Don’t forget to add proper supporting documentation for the
same.
4. Be
updated about pandemic related billing changes
Due to the recent pandemic of
Covid-19, there have been many changes in the reimbursable services, which are
causing trouble with the providers. This is especially true for telephonic
health services. Additionally, CPT code 99072
that became effective from September 2020 was created to cover the costs of
pandemic safety measures, including PPE. However, most of the commercial payers
have not implemented this code. It is good to put the claims related to this
code on hold. You can send them timely for submission to check whether the
payers are ready to receive them.
5. Timely
submission of claims
Each payer has a different deadline
for the claims submission. Editing any claims can cause delays, and they also
often push the submission beyond the given deadline. So if you miss a deadline,
the claim is usually denied. Create processes to ensure that all the payer’s
deadlines are met. You can include a workflow to alert the employees before the
date of claim submission.
6. Ensure
clean claims with the latest technology
Have your practice management
system built-in alerts to ensure all the necessary data are collected at all
meet-ups with the patients. While it might sound like a cumbersome process to
collect all data accurately, most of these processes can be automated with the
latest technology. Many software can review the claims before submission and
flag the ones that have missing information. These tech tools can also ensure
proper documentation and simply the process of claims submission.
Bonus
tip of 2021: Updated Medical Billing Legislation
It is essential to know about the
latest legislation updated by the state and federal authorities. One such
latest update for the medical billing
scenario in 2021 is the No Surprises Act. As per the 24/7 Medical Billing
Services experts, there are certain things to be noted in this act that includes:
·
All
kinds of health emergencies are included in the in-network billing rates. This
is to guard the patients against high bills in the crisis hours.
·
The
out-of-network providers must inform the patients about the medical charge
estimates with a proper break up beforehand.
·
Any
explanation of the billed charges requires proper documentation that the
patients and the concerned parties understand.
·
The
law encourages balanced medical
billing even
during emergencies.
Get in touch with our experienced medical billers to discuss more the
reasons and ways to avoid medical
billing denials.
About 24/7 Medical Billing
Services:
We are a medical billing company
that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7 Medical Billing Services
Tel: +1 888-502-0537
Comments
Post a Comment