Reducing Denied Claim Percentage

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Reducing Denied Claim Percentage
When you submit a claim to any insurance carrier,
it will either get paid, fully or partially, or
it might get rejected or it might get denied.
Most of the time, providers get confused between
claim rejection and claim denial. When a claim is
rejected, it generally means details mentioned in
the claim are either incomplete or
inaccurate. So, you need to provide accurate
and/or complete patient and insurance details for
a claim to get processed. But when your claims
got denied, means the payer has processed your
claim and denied the payment. Medical Billers and
Coders (MBC) is a leading revenue cycle company
providing complete medical billing and coding
services. In this article, we shared some basic
tips for reducing denied claim percentages.  Redu
cing Denied Claim Percentage Track Every
Claim The easiest way to reduce your claim
denial is to account for every submitted claim
accurately. Most practices, focus only on
submitting claims as quickly as possible and
wont track them. You need to track every single
submitted claim, to classify claims as paid,
denied, rejected, in process. As per market
standards, its quite normal to have around 10
percent as denied claims.
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Reducing Denied Claim Percentage
Its normal because you might be billing new
payers, new services, or patients might have
switched insurances. Make sure that your denial
percentage wont climb more than 10 percent at
any time. If you are not tracking the claim,
start taking follow up with all payers for claims
submitted in the last 9 to 10 months. Care
fully Read ERAs/EOBs Insurance carriers will
convey claim payment status using Electronic
Remittance Advice (ERAs) or Explanation of
Benefits (EOBs). Carefully read every line item
of remittance advice and can categorize claims as
paid, unpaid, and denied. You need a billing
expert who understands every denial reason and
remark code and reworks and submit the claim with
corrected or/and additional information. It will
ensure, you are not missing any claims and all
claims needed attention are corrected and
resubmitted on time. 
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Reducing Denied Claim Percentage
Find the Most Common Denials When you start
tracking every claim, you will find patterns in a
claim denial, whether it would be patient-wise,
payer-wise, or procedure-code-wise. After finding
the most common reason for your claim denials,
well-tested resolutions will help and you can
correct claims without much research. Some of
the common denial reasons are patients coverage
expired, prior authorization missing, diagnosis
codes inconsistent with the procedure, timely
filling limit expired. Once you realize the most
common denial reasons, modify your billing
process to avoid such denials in the future. For
example, once you discovered the need for prior
authorization for some procedure codes/ patients
then update your billing activities so that you
will undertake prior authorizations a few days
prior patients visit.  Appeal Every
Denial Stop leaving revenue on the table, appeal
every denial. If unsure, call the insurance rep
and check what additional documentation is
required. Examine every denial to see if theres
cause to appeal, if so, then move forward. Just
review the denial, appeal the denial, keep your
denial letter concise and factual.
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Reducing Denied Claim Percentage
Many billing software also offer, a scrubbing
feature, which will help you to predict claim
denial or rejection, before submitting the
claim.  Benefits Verification for Every Visit
Doing eligibility and benefits verification for
every patient visit is a must for reducing
denials. Benefits/insurance coverage report will
help you to understand insurance coverage,
patient responsibility, or the need for prior
authorization. There is some billing software
that provides the feature of checking benefits
reports, or you can check it through the provider
portal or you can simply call an insurance rep
and request them to send you a benefits report.
There is a standard script that you can keep as a
reference while calling the insurance
rep.  Ensuring that all your submitted claims
get paid, will ensure a steady flow of revenue
for your practice. Above mentioned tips will help
you in reducing denied claim percentage and
increasing paid claim percentage. If you are
struggling to receive accurate reimbursement for
delivered services from patients and payers then
we can assist you. Medical Billers and Coders
(MBC) is a leading revenue cycle company
providing complete medical billing and coding
services. We can assist you in reducing the
denial percentage and increasing your insurance
collections. To learn more about our billing and
coding services, contact us at info_at_medicalbillers
andcoders.com/ 888-357-3226.
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Reducing Denied Claim Percentage
FAQs 1. What is the difference between a
rejected and a denied claim? A rejected claim is
due to incomplete or inaccurate details, while a
denied claim means the insurance carrier has
processed it and refused payment. 2. How can I
reduce the percentage of denied claims in my
practice? Track every claim, carefully read
Electronic Remittance Advices (ERAs) and
Explanation of Benefits (EOBs), and identify
common denial reasons to prevent them in the
future. 3. Why is tracking every claim
submission important? Tracking ensures you
identify claims that are paid, denied, or
rejected and allows you to follow up on unpaid
claims, helping to keep your denial rate below
10. 4. How can I identify the most common
reasons for claim denials? By tracking claims
over time, you can spot patterns such as expired
coverage, missing prior authorization, or
incorrect diagnosis codes, and take steps to
address them.
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Reducing Denied Claim Percentage
5. What should I do if a claim is denied? Always
appeal a denial, review the reasons carefully,
gather any necessary documentation, and submit
the appeal to maximize your chances of getting
the claim paid.