Medical Billing

Minimizing Claim Rejections with Efficient Denial Management

Minimizing Claim Rejections with Efficient Denial Management

As observed by the experts in the medical industry, medical claims worth almost $3 trillion are submitted annually to insurance companies across the country. Amazingly more than $260 billion worth of claims out of the total amount are rejected. To top it off, around 60% of the said claims are not reconsidered by the companies that rejected them to begin with. This implies that the rate of revenue going to waste in the medical billing industry is alarming to say the least. Medical billing in its entirety, is a challenging feat with a myriad of technicalities to bare under consideration, which is why the healthcare practitioners are overwhelmed by it. With that said, under the current circumstances with the ever-changing medical rules and regulations, the essentiality of hiring a medical billing service provider becomes obvious. However, in the interest of effectively minimizing the claim rejections, following steps are to be taken by the medical billing companies:

  • The first order of business should be the eligibility check. A strong medical billing software often verifies the eligibility of the clients by itself. However, it is elementary that a medical billing company leaves no stone unturned in terms of verifying whether or not the client is eligible as per the parameters.
  • Remaining up to speed with the ever-changing rules, regulations and provisions of the industry is a crucial element to manage the claims effectively. Each change in the industry is likely to have a sizeable impact on the entire mechanism of claim management. Therefore, it is important for a medical practice and more so for a medical billing company to stay up to date in that regard to be assured of a stable and steady claims management mechanism.
  • Another crucial steps in claim management, is the verification of the insurance companies. This step requires meticulous observation since the patients tend to have numerous insurances at the same time. The point of concern lies in the selection of the correct insurance company to submit the claim. If the claims are sent out to the wrong company, they are sure to be rejected. The verification can be done through their patented template and other particulars that can help you select the correct insurance company to submit your claims.
  • Inhouse Demographic Classification is something that concerns the medical practice only. It is up to the front desk of a medical practice to do an accurate demographic classification of the patients. A single incorrect detail could result in the rejection of the claim, which is why it is important to observe and record every single detail meticulously.
  • Last but definitely not least, is double checking of the details. In pursuit of efficiency, even the experts can sometimes, albeit inadvertently, tend to skip out on a few details. Therefore, it is of utmost essence for the companies as well as the practitioners to double-check all of the particulars prior to submitting the claim in order to avoid denial or rejection.

Although the said elements are to be accounted for by a medical practice as well, a strong medical billing company is likely to have a system and resources in place that can manage the claims according to the said parameters. Therefore, it is advisable for all medical practices to hire the services of the best medical billing company in the market in order to strengthen the revenue cycle and make the pratice profitable.

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