3 Ways to Prevent Medical Claims Denials

Roughly ten percent of all healthcare claims are denied in the first round, requiring providers to invest additional time and money into the collections process in order to be able to secure payment. Here are a few pointers from our healthcare collections training team for preventing and resolving denied claims.

1. Get to the root of the problem.
The best way to start minimizing claims denials is to monitor your submission reports regularly in order to find out how many denials are coming in and what is causing them. If your revenue cycle management company employs a denials reporting system, you can automatically categorize each denial that comes in depending on what caused it. Alternately, every department can maintain a written or electronic log to keep track of the reason for each denial. Since a large number of rejected claims are the result of a handful of common mistakes, once you pinpoint the problem, addressing it and working on steps to resolve it should be a fairly simple process

2. Outline prevention tactics.
To assist you in figuring out how future denials can be avoided, form a team of staff members involved in the claims submission process. Ask employees to pay special attention to small details, such as entering patient identifier information correctly, making sure that all required referrals and authorizations are received prior to services being rendered, and confirming each patient’s insurance and covered benefits. Since it costs about $50 in human resources to process claims for resubmission or appeal, having your staff obtain the correct information the first time can save your practice money on unnecessary expenses. Remember that every claim you stop from becoming a denial means less follow-up work and a decreased risk of not getting paid.

3. Standardize the denial resolution process.
Providers should establish standard practices for handling denials. Though, ideally, your office would be denials-free, realistically you are always going to have a small percentage of denied claims coming in, and both you and your staff need to be prepared to handle them. Make sure everyone is aware of their role once a denial is received, including what steps to take and how long it should take to resolve each issue. For a quicker turnaround time, it is recommended for appeals and claim resubmissions to be sent out within 48 hours of having been received in your office, though each practice will have its own protocol. A revenue cycle management company can help appeal denied claims in an efficient and timely manner. What’s certain is that medical professionals who employ healthcare collections training tactics and take systematic action to prevent claims denials can expect to see significant improvement in their revenue cycle.

This information is not to be construed as legal advice. Legal advice must be tailored to the specific circumstances of each case. Although we attempt to provide up-to-date information, laws and regulations often change. We make no claims, promises, or guarantees about the accuracy or completeness of this document. For legal advice, please consult an attorney.