5 Best Practices to Reduce Claim Denials

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5 Best Practices to Reduce Claim Denials
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5 Best Practices to Reduce Claim Denials
Medical practices of all sizes dont pay
attention to claims that get denied. Most of them
just believe in submitting the claims, start
expecting insurance reimbursements. There is no
claim tracking, no claim follows up involve.
After a few months, they will start realizing
they are working more and earning less. Claim
denials are the obvious reason for reducing
insurance reimbursements. When you submit a
claim, the payer can either pay it or deny the
payment with a suitable denial reason. Provider
or billing staff need to study these denial
reasons and resubmit the claim with changes or
additional information. Common claim denial
reasons include missing or incorrect data
patient eligibility lack of medical necessity
duplicate claim submission lack of
documentation non-payable diagnosis codes lack
of prior authorizations and wrong procedure
codes. You can easily figure out that most of
the common claim denials are easily avoidable.
So, in this article, we have discussed 5 best
practices to reduce claim denials. You will be
surprised to know that about two-thirds of all
denied claims are recoverable, even then also
only 35 of them are resubmitted. 5 Best
Practices to Reduce Claim Denials 1. Track all
your claims
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5 Best Practices to Reduce Claim Denials
Just submitting claims is not enough, monitoring
and documenting each of your practices claims
and denials is crucial. It enables you to ensure
claims are submitted and appealed in a timely
manner, spot trends in denials, and maintain
detailed oversight of the portion of the claims
of your revenue cycle. Each patient encounter
ideally should be coded on the date of service.
Denied claims should be tracked by type and payer
when posting payments or at other regular
intervals. 2. Identify common claim denial
reasons   Routinely run a detailed report of
your practices denied claims. Though the
reason(s) for denial typically varies by
specialty and practice, this report allows you to
more easily pinpoint specific claims without
having to sift through multiple ones. Also
consider maintaining a log listing your denials,
including the type of denial, the date it was
received, and the date you appealed it. If you
notice a problematic trend through this
documentation, address it immediately to avoid
additional claim denials. After gathering denied
claim data, if you focus on top 3 denial reasons
you will be recovering more than 80 percent of
your lost reimbursements. 3. Track your denial
rate
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5 Best Practices to Reduce Claim Denials
Knowing the denial rate of your practice lets you
target areas that are especially troublesome for
your revenue cycle. We suggest the following
method to calculate your practices denial rate
add the total dollar amount of claims denied by
payers within a given period and divide by the
total dollar amount of claims submitted within
the given period. If possible, your rate should
also be computed by payer, provider, and reason
for denial. 4. Provide constant training for
your staff   Knowledge of complex and changing
documentation requirements (i.e., ICD-10) and
accurate data entry are key for billing staff to
correctly and expediently handling the claims
process. Ensure you have adequate staffing to
process claims and communicate regularly with
your team members about policies and procedures
that affect denied claims. Emphasize regular
training to keep employees updated on the new or
updated procedure and diagnostic codes, appeals
processes, and instructions particular to each
payer. 5. Check insurance coverage for every
visit   The eligibility and benefits
verification process ensures that you will
receive all the reimbursement you deserve. It
will help you to understand if the patient has
active coverage or not what services are
included what is patient responsibility is
there any need for prior authorization and many
others.
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5 Best Practices to Reduce Claim Denials
Eligibility check before every patient visit will
ensure that you will have all the correct
information to fill the claim, which makes fewer
chances of the claim getting denied. You can
simply call the insurance rep and understand
patient coverage payable procedure codes, and
understand the medical necessity. Above
mentioned 5 best practices will definitely help
to reduce claim denials. To implement these 5
best practices, you will require the providers
time and expert medical billing staff. As the
providers are busy in patient care and expert
medical billers are difficult to retain,
outsourcing your billing could be a practical
solution for denial management. Medical Billers
and Coders (MBC) provides denial management and
resolution service which includes eligibility
verification clean claim submission claim
tracking accounts receivable (AR) management
and reporting. All these functions are conducted
by billing and coding experts as per your medical
specialty. If you want to know how we can assist
you in reducing claim denials and increasing
insurance reimbursements, contact us
at info_at_medicalbillersandcoders.com/ 888-357-3226.
FAQs
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5 Best Practices to Reduce Claim Denials
1. Why do claims get denied? Claims are often
denied due to errors in coding, missing
information, or improper documentation. 2. How
can accurate coding help reduce denials? Correct
and up-to-date coding ensures claims are
processed accurately, minimizing rejection
risks. 3. What role does patient eligibility
verification play? Verifying patient insurance
details before treatment prevents denials due to
coverage issues. 4. How does timely submission
reduce denials? Submitting claims promptly
avoids missing payer deadlines, which can lead to
denials.   5. Why is follow-up important for
denied claims? Timely follow-up helps resolve
denial reasons, ensuring quick resubmission and
faster reimbursement.  
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