How to Prevent Medical Billing Claim Denials?
MGSI provide best Anesthesia medical billing Services in united states. https://www.mgsionline.com/anesthesia-billing.html
1. How to Prevent Medical
Billing Claim Denials?
www.mgsionline.com
2. While ensuring efficient patient care, Providers and healthcare practices work
24/7 to improve their billing performance and revenue.
However, the introduction of new medical reforms in the US healthcare industry
have complicated their goals.
New coding techniques and insufficient training contributed to more claim
denials.
It is estimated by the Medical Group Management Association (MGMA) that
even the exceptionally performing medical practices end up with 4% claim
denials.
Then imagine the claim denial rate of developing healthcare practices.
It is also estimated that almost 65% of claim denials are never
corrected and refiled.
Even if healthcare practices take initiative and correct the denied
claims, they don’t submit before the time frame of 90 days.
All these factors affected many healthcare practices’ revenue cycle
badly.
In this article let’s see how we can prevent medical billing claim denials
and improve cash flow through efficient denial management
3. Analyze and Determine
the Cause
Avoiding claim denials involves a series
of steps and the first one is to analyze and
determine what causes claim denials in
the first place.
Right from the frond-end to back-end
services, there are several operations,
which if not carried out properly can
resort to claim denials. They are as
follows,
4. 01
Patient Registration
This is the very first step when a patient visits a
healthcare practice and if it is not shown proper care,
then there can be a huge amount of claim denials.
Front-office staff should make sure that they register
the patient details accurately while verifying their
insurance benefits and eligibility.
5. 02 Coding:
Accuracy in diagnosis and procedure codes is
crucial to proper denial management. Carrying
out the wrong diagnosis or coding incorrectly can
result in a lot of claim denials.
It is for this purpose that healthcare practices
should offer enough training to their staff to
carry out unsurpassed medical billing functions
as per the new coding techniques.
6. 03
Billing
Sometimes, staff submit duplicate
claims meaning they file a claim for
a service more than once.
Such internal mistakes are perfectly
avoidable and the denial
management team should check
twice before the claims are filed.
7. 04
Filing
Claims have a certain time limit before
which they have to be filed.
The time limit varies from payer to
payer.
Insurance companies will deny the
claims simply if they are filed beyond
this time limit.
8. 05
Payer:
After analyzing all the factors, if there
are no mistakes from the Providers’
end, then the denial management team
must look into the Payer.
Sometimes, payers make errors while
processing the claims.
If so, then call the respective insurance
company and address the issue.
9. 06
Prioritize
Once Providers fix the root cause of their
claim denials, they should set up a good
denial management team.
The team will further analyze which factors
cause the highest impact and prioritize.
The causes are then eradicated one by one
in the order of the prioritization
10. 07
Claims Management Software
Yet another important step in managing
claim denials is setting up a proper claims
management software in to your system.
The denial management team should use
data analytics and study the pattern of
claim denials to optimize the software and
offer great solutions.
This enables healthcare practices avoid
claim denials in the future.
11. About MGSI:
All the aforementioned steps can be done proficiently by a
reputed medical billing company.
Therefore, partnering with one will save ample costs for healthcare
practices.
If you are looking for a highly-experienced organization then look no
further than MGSI, a one-stop-shop to all your medical billing needs.
This Florida-based company has more than 20 years of experience
providing exceptional denial management services to its clients.
To learn more details, log on to www.mgsionline.com.
12. CREDITS: This presentation template was created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik and illustrations by Stories
Thanks!
Does anyone any questions?
Mail us: info@mgsionline.com
Call us: +1 813 666 0028
Website: www.mgsionlne.com