Claim denials pose a significant problem to medical facilities' bottom lines. Despite plenty of due diligence and training, denials are bound to happen. In fact, many denials occur as a result of the same error time and time again.
In this case, by understanding where this repetitive error originated you will be able to take proactive measures to reduce the occurrence of future denials. The following are some best practices that will also aid in minimizing denials.
Data entry errors, which are easily preventable, represent a large portion of claim denials. According to HealthcareFinance.com, "While approximately two-thirds of denials are recoverable, 90 percent are preventable."
Each claim denial requires additional time in terms of research, corrections, and re-submissions, thus prolonging the payment process further. If measures are put into place to prevent denials, you'll experience a more successful revenue cycle management program.
Ongoing training and round-table meetings should be held with the administrative team on a regular basis to facilitate feedback and allow experienced staffers to share their experience and knowledge with newer team members.
Emphasize the importance of eliminating errors on claims submissions such as:
- Incomplete or incorrect demographic information
- Charge codes not covered by the patient's plan
- Missing preauthorization or precertification
- Duplicate claims
Simple data entry mistakes can mean a big thing to your organization's bottom line. If someone can't tell the difference between a 4 or a 9, an erroneous guess can cost weeks in the payment process, thus impeding the revenue flow.
By integrating medical technologies such as patient self-check-in kiosks and tablets that allow patients to enter their information themselves, your administrators are left less susceptible to guesswork.
Additionally, at the onset of an appointment, it is important to have a team in place who can perform verification processes to ensure a smoother transition.
Items that should be included in your proactive troubleshooting techniques include the following:
- Has the patient's benefit maximum already been met?
- Will the patient be using a secondary insurance, as well?
- Are preauthorizations required? Have you obtained information necessary to submit the preauthorization with the claim?
- Is the patient's insurance still active?
Understanding why claims are denied is an essential first step to increasing your facility's overall revenue management. You don't have to take this first step alone. At MedClaims we have a dedicated team that can provide insight and guidance while identifying where errors where made. To learn more about how MedClaims can help you please contact us at sales@medclaimsint.com.