How Can Medical Billers Avoid Claim Denials?

Medical Billers Avoid Claim Denials

Medical billing is a critical process in the revenue cycle management of every healthcare providing organization and helps the healthcare provider get its dues in the form of timely claim reimbursements for the services provided. A medical billing denial results in revenue losses for the provider and affects the bottom line negatively. A medical bill denial is the refusal of an insurance company to honor the claim submitted by a healthcare provider for the services provided by it. This is a huge loss to the healthcare providers who invest a lot of time and energy in providing quality care to patients as they are not paid for the services they have already provided.

Healthcare providers should work towards reducing their medical bill denials and improving their revenue cycle management but which is not an easy thing. Although controlling claim denials is challenging it can bring a lot of efficiencies and show a substantial effect on the financial position of the healthcare provider. Some claim denials can be categorized as hard denials that cannot be corrected and result in revenue loss while some denials can be categorized as soft denials that can be corrected with the possibility of getting paid. Top RCM services providers have listed out a few ways medical billers can prevent the medical billing denials.

  1. Complete information – The basic step to avoid denials is providing the insurance payer with all the complete information required without missing on any details. Many times, due to lack of time, to skip lengthy procedures or by mistake, billers tend to give incomplete information to the insurance companies leading to claim denials. The medical billers should be extra cautious while providing the patient information regarding the demographics, medical codes and modifiers applicable, insurance plan code, etc.
  2. Avoid duplication – One of the major reasons for claim denials is submitting duplicate claims for the same services provided on the same date for the same beneficiary. By avoiding duplication, healthcare providers can avoid and reduce claim denials substantially.
  3. Avoid claiming for services already adjudicated – RCM services professionals insist on double-checking the claim forms before submitting to verify if any particular service that has already been adjudicated is included again. If such inclusion is done, the claim gets denied which is totally avertable.
  4. Cross-check the services covered – Before submitting the claim forms or even before providing the services, it is fundamental to verify if the services being provided are covered by the insurance plan of the patient. It is always helpful to confirm the insurance eligibility of the patient by going through the plan documents or communicating with the insurer before providing the services to avoid any denials at a later stage.
  5. Filing within the timeframe – To avert one of the major reasons for claim denials, RCM services professionals have to make sure that they submit all their claims within the timeframe stipulated by the various insurance payers. Different insurance companies, Medicare and Medicaid have different rules and regulations regarding the claim submissions and the medical billers ought to know all these thoroughly so as to not miss any deadlines and avoid denials for this reason.

Taking appropriate measures to avoid claims denials along with having a robust claim denial management process in place is an absolute necessity for all the healthcare providers to have a healthy revenue cycle and improve their bottom line so as to provide much better quality care to the patients.

How Can Medical Billers Avoid Claim Denials?
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