Medical claims are an unavoidable part of life for physicians and healthcare providers. Unfortunately, it often seems like claim denials are equally as unavoidable, despite the significantly negative impact they can have on revenue cycle management. In truth, it's not always as difficult to reduce denials in medical billing as you may think. The key lies in understanding why your claims are being denied in the first place. Once you have a solid grasp of the reasons, you can implement changes that will reduce denials going forward.
Here's a look at a few ways providers can reduce denials in medical billing:
1. Embrace Automation
If your organization runs on manual data entry, it's ripe for costly errors. There are thousands of diagnostic codes and insurance policy requirements, and it can simply be exhausting for humans to keep up with all of these various elements. Automate as many processes as possible, utilizing medical billing software that can convert and update codes and requirements as needed. This allows your team members to focus on reviewing data to ensure it's correct, rather than spinning their wheels doing research.
Medical billing software also helps streamline documentation and flags potential problems before claims are submitted, thereby allowing staff members to resolve issues before the lengthy denial process begins.2. Require Ongoing Training
Training doesn't have to be formal, but it does need to be done regularly. Many claim denials are the result of minor errors that could have been prevented if the billing team was more properly trained. Host frequent training sessions, and be sure everyone who impacts billing is included. The medical billing team, providers, front desk staff, and managers should all be made aware of the importance of legible, accurate, and error-free documentation.3. Ask Your Staff for Feedback
Your billing team is your frontline to success. They see a lot of problems and opportunities you may not even realize exist. Facilitate round-table forums, which allow everyone from new hires to seasoned employees to share their thoughts and experiences. Make sure you offer an environment where learning is encouraged so employees aren't fearful of being punished if errors occur beyond their powers.
Medical Economics explains this situation well with a quote from Owen Dahl, principal of Owen Dahl Consulting. “Eighty-five percent of the time an employee is involved in an error, a system causes the error, not the employee."4. Be Prompt with Follow-Ups
The sooner your staff can reach out to the payers to rectify denial situations, the more likely your claims are to be paid. Claim denials should be addressed within a week, including review, correction, and resubmission. As noted by Medical Economics , "...by correcting claims, such as by adding requested information, and sending them back to payers quickly, [Woodcock says] that at least 80% of them eventually will get paid."5. Work Denials Daily
Pile-ups can happen quickly. To avoid this pitfall, designate a team to work denials for a certain amount of time each day. This will help prevent missed deadlines and minimize the overwhelming number of denials that can easily add up if they're not tended to regularly. No claim should ever be late, and by scheduling denials into the daily workflow, you should be able to achieve a 0% denial resulting from untimely submission.
It's essential to have processes in place that support positive revenue cycle management. Each claim denial is not only costing your organization money, it's also causing your team members to experience a lot of frustration and wasted time as they work to correct errors and resubmit the claim. To reduce denials in medical billing at your facility, first, implement procedures to track the reasons your claims are being denied. From there, you can begin to resolve the issues at large, creating a more fruitful revenue cycle while reducing your team's frustration and workflow bottlenecks.