5 Effective Strategies To Prevent Medical Claim Denials Management
September 30, 2022
If you struggle with medical claim denials, you are probably not alone. A study by the American Medical Association (AMA) showed that insurance companies deny nearly 20 percent of all medical claims. While this number may not be concerning at all, it may damage the reputation. Medical claim denials can be a huge headache for any business.
On the bright side, there are some practical strategies that you can use to prevent claim denials. Let’s talk about some common reasons for the denial and how you can avoid them.
1. Find The Underlying Causes of Denials
The first step to preventing medical claim denials is to find their underlying causes. It can be a daunting task, but it’s essential to do your research and identify the root cause of the problem. Once you know what’s causing your denials, start working on fixing the issue.
Some of the common causes of medical denials are:
- Incorrect coding
- Incomplete or missing information
- Billing errors
2. Use Cutting-Edge Technology
Medical technology has made it easier than ever to submit claims electronically. It reduces the chances of errors and speeds up the claims process. In addition, many insurance companies now offer online portals that allow providers to check the status of claims and appeal denials. Many credible software applications are also available to help providers track claims and denials.
3. Review Claims Before Submitting
One of the most effective approaches to prevent claim denials is to review claims before they are submitted. It will help in catching any errors or omissions that could lead to a denial. Getting it checked by others can help you catch any mistakes you may have missed. Submitting accurate and complete claims is the best way to avoid denials. However, even the most meticulous claims can be denied if they are not appropriately submitted.
4. Eligibility Verification Is A Must
When submitting a claim, be sure to verify the patient’s eligibility first. The last thing you want is to submit a claim and have it denied because the patient wasn’t eligible for coverage. You’ll need to contact the patient’s insurance company to verify eligibility. They will tell whether or not the patient is currently covered and what their coverage entails. If you don’t verify eligibility beforehand, you risk wasting time and resources on a claim that’s doomed to be denied.
5. Ensure Accurate Documentation
One of the essential things to prevent claim denials is to ensure that your documentation is accurate. Inaccurate documentation is one of the most common reasons for claim denials, so it is vital to take the time and get it right. It includes ensuring that all required information is included on the claim form and that all diagnosis and procedure codes are valid. Ask your billing specialist or coder for help if you are unsure about anything.
In A Nutshell
Medical claims are now an indispensable part of the healthcare industry. They help to ensure that patients receive the treatment they need and deserve. However, medical claims can be denied for a variety of reasons. By understanding the most common reasons for the denial and implementing effective strategies to prevent claim denials, healthcare providers can improve their chances of getting paid for their services.
Incorrect medical coding is one of the biggest reasons behind claim denials. What if we can help you with that? We provide expert medical billing and coding services that can help you get paid for the services you provide. Contact Quelin Billing today to start your stringent and quality medical coding services.
Have Any Question?
Reach out to Quelin Billing for expert assistance in medical billing, coding, and practice management, tailored to your healthcare needs.
- 210-245-7698
- [email protected]
