In medical billing, and the overall process of healthcare revenue cycle management, the efficient processing of medical insurance claims is essential for all medical practices. Without this process in place, a medical facility’s cash flow can quick become disrupted. Earlier ABCS RCM blog articles have presented ways to prevent denied claims. But since this is an amazingly important topic, we felt that additional advice was merited.
Almost every medical practice or health professionals will have to grapple with medical claim denials from insurance payers. Managing these denied claims often requires one of a healthcare provider’s most valuable resources – office time. With the challenges of the modern healthcare environment, time is not a resource that should be wasted.
Billing managers and support staff have to process the same insurance claim twice, which not an efficient use of office hours. Many denied claims are repeatedly generated due to a limited number of reasons. In order to actively prevent denials from hurting a practice’s cash flow and overall revenue cycle. There are a number of steps that healthcare providers can undertake which will prevent or at least greatly reduce errors.
3 quick steps to reduce denied claims:
 Changes in eligibility: Office staff must strive to accurately determine a patient’s insurance coverage. This includes co-pays, deductibles, secondary insurance, etc. Sometimes, a patient’s insurance coverage will change without the patient ever knowing it. Ideally, health professionals should initiate a payment collection method before delivering any services. However, sometimes this is not possible. Contacting the patient and insurance provider is always the safest policy.
 Inaccurate patient demographic information: Always verify that the most up-to-date and accurate information is submitted to insurance payers. Back office and/or medical billing staff should constantly focus on making sure that every submitted claim possesses the most current information available. In these cases, the claim is actually rejected by an insurance payer due to clerical mistakes. These mistakes can include everything from incorrect patient DOB, name, ID number, policy number, address, etc. Once the incorrect or missing information is added, the claim can be re-submitted but this takes time.
 Duplication errors: Medical billing staff needs to have a constant and transparent workflow which allows them to monitor every stage of the claims submission process. For example, if a healthcare provider submits a claim for a service that has already been rendered, to the insurance company it appears a patient received two identical treatments, on the same day and by the same healthcare provider.
This double billing is usually denied by insurance payers. If the insurance payer initially fails to catch the duplication errors, they will likely discover the mistake over the next few months. When this occurs, the insurance payer will likely file a takeback request from the healthcare professional. Care should always be taken to ensure that an individual claim is only submitted once.
Many factors can create medical billing problems, which is why office staff should always push to provide the highest level of accuracy when processing claims. However, only three of these factors are corrected, the problem of denied claims is quickly eliminated or at least greatly reduced.
ABCS RCM provides experienced medical billing for a variety of healthcare providers.To learn more about this topic or for general questions, email or call ABCS at 614-890-9822.
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