Tackling the Challenges of Claims Denials: Insights for Healthcare Providers

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers

• Challenges of Claims Denials
• Claims denials are a major challenge for
  healthcare providers in the United States.
  According to the Medical Group Management
  Association (MGMA), the average claim denial rate
  in 2023 is 7.5. This means that for every 100
  in claims submitted, healthcare providers are
  losing an average of 7.50 to denials. But why do
  claims get denied in the first place?
• The top five reasons are
• Incorrect or incomplete patient information
• Improper coding
• Non-covered services
• Missing or inadequate documentation
• Lack of medical necessity
• While some claims denials are unavoidable, many
  can be prevented with careful attention to detail
  and a thorough understanding of the claims
  process.

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers

• The Financial Toll of Claims Denials
• Denied claims are more than just an
  inconvenience they have a direct impact on the
  financial health of a medical practice. Heres
  how
• Cash Flow Disruption Denied claims mean delayed
  payments or, in some cases, no payment at all.
  This disrupts the cash flow of the healthcare
  provider, making it challenging to cover expenses
  like salaries, rent, and equipment costs.
• Increased Administrative Costs Dealing with
  claims denials requires additional administrative
  work. Staff must review and appeal denials, which
  consumes valuable time and resources that could
  be better spent on patient care.
• Provider-Payer Relationship Strain Frequent
  claims denials can strain the relationship
  between healthcare providers and insurance
  companies. A tense relationship can lead to
  delays in processing future claims or even
  provider contract terminations.
• Strategies to Overcome Claims Denials

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers

• Now that weve dissected the challenges of claims
  denials, lets explore some strategies to
  overcome them and ensure a smoother billing
  process.
• Streamline Data Entry Minimize errors by
  implementing robust data entry processes. Use
  electronic health records (EHR) systems that can
  reduce manual input and the likelihood of
  mistakes.
• Staff Training Invest in staff training to
  ensure they are well-versed in billing procedures,
   coding, and insurance requirements.
  Knowledgeable staff are your first line of
  defense against denials.
• Automate Prior Authorization Implement systems
  that automate the prior authorization process.
  This helps ensure that necessary approvals are
  obtained before providing services.
• Regular Audits Conduct regular audits of your
  billing processes to identify and rectify errors
  before they lead to denials.
• Insights for Healthcare Providers
• There are a number of things that healthcare
  providers can do to tackle the challenges of
  claims denials, including

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers

• Verify patient eligibility and coverage Before
  providing any services, verify the patients
  eligibility and coverage with their insurance
  company. This will help to ensure that the
  services are covered and that the patient is
  responsible for the correct co-pay or deductible.
• Obtain prior authorization If prior
  authorization is required for any services,
  obtain it from the patients insurance company
  before providing the services.
• Review claims before submission Before
  submitting claims, review them carefully for any
  errors or omissions. This will help to reduce the
  number of denials.
• Submit complete and accurate documentation When
  submitting claims, be sure to include all of the
  required documentation. This includes the
  patients insurance information, the date of
  service, the procedure code(s), and the diagnosis
  code(s).
• Implement a denial management process Providers
  should have a process in place for reviewing and
  appealing denied claims. This process should be
  efficient and timely to ensure that denials are
  resolved quickly.
• Invest in training Providers should invest in
  training for their staff on medical coding and
  billing procedures. This can help to reduce the
  number of coding errors and incomplete claims.
• Use a medical billing company A medical billing
  company can help providers to manage their claims
  and appeals process. This can free up providers
  time and resources so that they can focus on
  patient care.

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers

• By following these tips, healthcare providers can
  take steps to reduce the number of claims denials
  and improve their financial performance.
• About Medical Billers and Coders (MBC)
• Medical Billers and Coders (MBC) is a reliable
  medical billing company that can help you tackle
  the challenges of claims denials. We have a team
  of experienced and certified medical coders and
  billers who are experts in all major insurance
  payer policies. We also have a dedicated denial
  management team that works tirelessly to appeal
  denied claims and get them reimbursed.
•  
• MBC can help you reduce claims denials in a
  number of ways, including
• Accurately and completely coding and billing
  claims
• Verifying patient eligibility and coverage
• Obtaining prior authorization for required
  services
• Submitting complete and accurate documentation
  with all claims
• Following up on claims with insurance payers to
  ensure timely processing and payment

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Tackling the Challenges of Claims Denials
Insights for Healthcare Providers
We also offer a variety of other services to help
you improve your revenue cycle, such as patient
collections and account receivable management. If
you are looking for a medical billing company
that can help you reduce claims denials and
improve your financial performance, MBC is the
right choice for you. Contact us today
at info_at_medicalbillersandcoders.com / 888-357-3226
 for a free consultation.