MedClaims International Blog

Improve the Claims Management Process by Preventing Payer Denials

Posted by Brady Dolan on Dec 6, 2016 4:02:00 PM

Over the past few years, healthcare costs have continued to rise, and the intricacies involved with medical billing have only become more complex. With each change and evolution in compliance regulations, healthcare providers are experiencing more and more claim denials, which ultimately hurt their bottom line. The more complicated the revenue cycle management process becomes, the less revenue healthcare providers are receiving.

Below is a list of 5 helpful processes that can be put in place to help prevent payer denials and help to increase your bottom line.

  • Implement Technology
    Human errors cause a great deal of claim denials. Administrative staff spends a great deal of time trying to accurately determine letters and numbers on hand-written forms. Ultimately, some guesses will be incorrect, which can result in unnecessary claim denials.By implementing self-check-in kiosks and utilizing other available technologies, medical facilities can eliminate unnecessary human errors.
  • Conduct Ongoing Training
    In the ever-changing world of health care, facilities should never stay stagnate in furthering their education. Ongoing training sessions should constantly be conducted with staff members so they can share their experiences and share their knowledge in regards to potential pitfalls so that they can be avoided in the future.
  • Understand Coding Requirements
    Each diagnosis must be coded correctly in order to avoid claim denials. It is imperative that your staff has access to the resources necessary to enter claims properly. Every claim submitted must be specific, down to the last digit.
  • Submit Claims on Time
    It's understandable that the administrative staff is very busy. There are plenty of patients to see, questions to answer, and tasks to complete. Unfortunately, insurance companies aren't concerned with facilities' workloads.To avoid denials as a result of untimely submissions, facilities should designate specific staff members who are solely responsible for reviewing and submitting claims. This dedicated team can also be helpful in reviewing any denials that are later returned. This will help to ensure that any returned claims are properly corrected upon re-submission.
  • Proactively Pursue Eligibility Information
    Many denials occur as a result of ineligible claims. To overcome this challenge, physicians' offices should take measures to gather patients' insurance information prior to the visit. This measure will allow staff members to contact the insurance agency, determine any additional requirements, and prepare the patient for potential out-of-pocket expenses.Claim denials will continue to be an enormous burden for healthcare providers, but there are certainly measures that can be taken to proactively eliminate lengthy turnaround time and paperwork revisions. With these five management processes in place, providers can prevent many claim denials, thus removing financial burdens.

Topics: claims