This document discusses how medical practices can reduce denied claims and improve revenue. It notes that practices typically lose 7-10% of revenue to denials that could be resubmitted. It recommends keeping denials below 4% and identifies common reasons for denials like incomplete information. It suggests practices review denial reports, train front desk staff to collect accurate data, ensure accurate coding, have clear policies, and address any issues found to minimize denials and resubmit successfully. Technology like EHRs can help by automating tasks and identifying errors.

1. Don’t Deny your Denials: What do Denials say
about your practice?
© CureMD Healthcare

2. Fall in Revenue
• A typical Medical Practice can easily lose 7%-10% of
its revenue to denied claims that could successfully
be amended and resubmitted.
• Add to that the difficulty, at times the impossibility,
of collecting from patients directly, and you’d be able
to comprehend the extent of revenue you are losing
despite enhanced workload.

3. Patient Collections
• Patient collections might be a hard nut to crack.
Thus, your immediate focus should be to ensure that
denials are kept at a minimal. One often-quoted
best-practice recommendation is to hold denials to
4% or less. Difficult but doable.

4. Suggestion
• Advisory Company, a hospital research organization
suggests that approximately 90% denials can be
prevented.
• Making sure that you are on the top of your denials,
preferably minimizing them, makes financial sense
too.
• Not only do you lose money if a denial is not
reversed; you also end up spending a considerable
amount of money appealing for denied claims.

5. Suggestion
• MGMA report pens down this cost to around $ 25
per claim. Thus, if your staff reworks 100 claims
every month, it’s costing you $2,500/month (That’s
more than what outsourcing your billing will cost!)
• Thus, it is worth your time to revisit your practice
workflow to identify and rectify problem areas.

6. Where is the problem?
• If a practice is losing revenue in denied claims, then it
is time to investigate the reasons behind the loss and
come up with solutions to prevent it.
• Certain issues may differ depending on the practice,
but most of them are standard problems found
across the board.
• Your EMR Software should enable you to pull out
reports on denied claims; you should review and
analyze them at least once a month.

7. Where is the problem?
• Claims can be denied due to:
– Incomplete patient information
– Incorrect patient demographic information
– Incorrect charge codes that do not cover patient’s
insurance plan
– Duplication of claims submitted
– Termination of insurance plan before physician provides
the service
– Incorrect provider name, or no name at all
– Patient benefit limit utilized

8. How to fix it?
• After identifying the problem, address the issues
with the relevant staff in your practice. Some
important points of intervention are:
• Front-desk staff: The first point of interaction
between the practice and patient is the front desk. A
lot of important billing functions rely on your front
desk doing their jobs correctly. It includes
– validating insurance for each and every visit
– collecting copays
– Getting correct addresses, phone numbers, email
addresses, etc.

9. Front-desk staff
• Many practices make the mistake of not investing
enough time in training their front staff. This is a big
mistake as your front desk will be interacting the
most with your patients.
• Thus, make sure that they are well versed with your
practice’s financial policy and adept at collecting and
verifying patient information.

10. Front-desk staff
• A best practice is to deploy technology to assist your
front desk rather than expecting them to wear
multiple hats. Electronic Health Record (EHR) should
help through
– Eligibility Verification: Some EHRs have the capability to
verify insurance eligibility in less than 3 seconds.
– The system provides you the most up to date information
on copays, deductibles, plan coverage and limitations.
– Your staff can save precious time by not having to call the
insurance provider or the payer.

11. Front-desk staff
– OCR Scanning Capability: Rather than manually type
information, you can integrate an OCR scanner with your
EHR to populate demographic and insurance information.
– Simply scan the front and back of your patient’s driving
license and insurance card.
– This process has a 99% accuracy rate and reduces
documentation considerably.

12. Medical staff
• Physicians should ensure that they convey the
accurate procedure and diagnoses codes to their
billing staff to avoid coding errors. Correct coding and
use of modifiers is the physician’s responsibility
• If the problem lies not in the coding itself but in
communicating it correctly to the staff you can utilize
technology to assist you in this.
• If you have an EHR try to create an interface with
your practice management solution so that this
information is electronically transmitted to the biller

13. Medical staff
• A best practice in this regard is to buy an integrated
EHR and Practice Management solution rather than
two standalone systems.
• Integrated solutions ensure that the correct CPT and
ICD codes are automatically transferred in real time
to the billing department, reducing the chances of
error.

14. Office policy
• Every practice should have a comprehensive policy
for payment collections.
• The policy should include conditions in case an
insurance plan is changed in the middle of the
treatment, terminated before the patient’s visit or
reaches its maximum benefit limit.
• Moreover, patients must be informed beforehand
about their responsibility to avoid misunderstandings
in the future.

15. Billing staff
• The Medical Billing sends out claims to insurance
providers after scrubbing them.
• Thus, if a claim is denied because of missing or
incorrect information such as failure to attach
primary EOB with secondary claim, incorrect
provider name or not including PAN with the claim;
you need to address these issues with the billing
staff.

16. Billing staff
• A good EHR automatically withholds the submission
of these claims by placing them in the ‘Incomplete
claim Bucket’.
• All your biller needs to do is to open the incomplete
claim and fix the errors that the system has
detected.
• With a good EHR system there should be nothing
stopping you to reduce denials at this end.

17. Reason for Rejection
• 80% of the time many practices fail to comprehend
the rejection reasons provided by the insurance
company.
• This can delay resubmission of denied claims or
prevent a practice from correcting these mistakes
beforehand.
• A proficient biller will be able to identify these
problems with time.

18. Reason for Rejection
• However, again this is where a good EHR/PM can
help you save time. It has a ‘rejection response’
capability that interprets rejection into a clearer easy
to understand description.
• Unless you conduct an internal audit, you will never
be able to fix problems. Make it a policy to spend
some time every month reviewing your EOBs and list
the problem areas.

19. Reason for Rejection
• Regularly conduct sessions with your staff to address
the issues at their end and let them know that their
personal evaluation will include correction of these
problems.
• This will help you solve multiple problems, and you
can start getting paid faster and appropriately.

20. Read more on blog.curemd.com
• To read more on this topic, visit:
• http://blog.curemd.com/dont-deny-your-denials-
what-do-denials-say-about-your-practice/

21. CureMD Healthcare
55 Broad Street, New York, NY 10004
Ph: 212.509.6200
www.curemd.com
Thank you!