If you’re like most medical practices, your goal is to keep the denial rate low. After all, the less money you have to spend on denying claims and chasing down payments, the more money you have to take care of your patients. According to the Medical Group Management Association, the highest performing medical practices average an insurance denial rate of only 4 percent. In this blog post, we’ll discuss some tips that will help you keep your denial rate low and protect your bottom line!
What is Claim Denial, and how does it work?
In a nutshell, claim denial is the process by which an insurance company decides that a particular claim is not payable. This can be for a variety of reasons, such as the services being billed were not provided, the services were not necessary, or the services were not covered under the patient’s insurance policy.
Claim denial can be a complex and frustrating process for doctors and physicians.
Here are five tips to help you keep your denial rate low and protect your bottom line:
- Make sure you are billing for services that were actually provided. This may seem like common sense, but it’s easy to make mistakes when you’re busy taking care of patients.
- Make sure you are billing for services that are covered by the patient’s insurance policy. This can be tricky, since insurance policies can be complex and change frequently.
- It is important to work with an insurance specialist who understands the specific coverage details of your patients’ policies.
This will help you avoid billing for services that are not covered by their insurance plan.
If a claim is denied because it was not covered by the patient’s policy, you may be able to appeal the decision.
But remember, appealing a denial takes time and resources, so only do this if you feel confident that the denial was incorrect.
In addition to these tips, it is also important to stay up-to-date on the latest changes to insurance policies and billing procedures. This can be challenging, but it is important in order to ensure that you are billing for services that will be paid by the insurance company.
If you need help staying up-to-date on the latest changes, consider working with a medical billing specialist. They can help you make sure your practice is compliant with all of the latest regulations and guidelines. By following these tips and working with specialists, you can keep your denial rate low and protect your bottom line!
Code Diagnosis to the Highest Level of Specificity
The more specific your coding, the less likely you are to receive an insurance denial. That’s because most private payers and government agencies require ICD-9CM codes with high specificity per HIPAA like CMS – which means they will only accept diagnosis from doctors who use them too!
It is important to use the right code for each category so that you can properly identify what information they contain. For example, if there are no fifth-digit sub classification codes in a given field then assign 4 digit numbers instead of 5 Digit ones because these do not accurately represent all aspects or details about an object’s complexity as seen through its categorization tree structure. Codes must be clear and concise but also accurate at any cost!
File Claims On Time
Missed deadlines are the leading cause of claim denials. If you miss a deadline, your insurance company will usually deny your claim and that can be expensive for any medical emergencies that come up in between then and now! To avoid this from happening: develop processes to ensure every payer’s requirements are met; use an electronic patient schedule as starting point so all submitted papers have actually been received (even if it takes some time); establish good surveillance at both ends – on paper by making certain cheat sheets or manual files don’t get lost. It is possible that even electronic submissions can fall through these cracks and never reach payers, despite showing successful transmissions on receiving end terminals!
It’s vital to stay up-to date with the ever changing requirements for medical billing
For medical billing companies, the idea of staying current with changes in codes and regulations can be costly. This is because they require a lot from your practice financially- not just time or money but also staff members who are trained on how to use new software systems so you don’t have any lost income as well!
Throughout the entire process, keep track of the claim
It’s crucial to keep track of your rejected claims throughout the process, otherwise you may never find a solution that gets them paid. A recent study from UC doctors found practices spend 8-14% on follow up with clerical staff and another 2%-5% for processing time per claim; this could be reduced dramatically by partnering up with an effective medical billing company who employs proactive processes like those we have here at MD Syhealth!
Insurance companies are not always willing to pay out in the event of a denied claim. But, if you follow these steps and have an appealing attitude then there should be no issue getting your money! Contact our team at MD Syhealth for more information about how we can help increase revenue through coding assistance or better appeals practices- contact us today so that together let’s make sure every last penny counts.