Protect Your Practice From Costly Claim Denials

According to Beckers Hospital Review, if the revenue cycle of your medical practice fits the norm, you could be seeing 15 to 20 percent of your claims denied on the first submission. Although reworks and appeals may ultimately succeed for most of your denied claims, spending the time and resources on follow-up still takes a big bite out your organization’s profits. That’s the bad news. The good news is that you can implement several strategies to protect your practice from expensive and unnecessary claim denials.

Put Accurate Patient Information at Your Fingertips

In a practice steeped in manual processes, information tends to stay where it’s collected until it’s transcribed into the practice management application. Many of these legacy systems still aren’t integrated throughout organizations. Front office, clinical providers and back office staff engage in quite a bit of data entry and transcription before a claim can be filed. Every point of manual data entry is a weak link in the chain of your revenue cycle. With integrated applications for each department, however, data need be input only once and verified for accuracy. At that point, it should be available for all interested parties. The billing department should have all pertinent records needed in one location by which to fill out claims appropriately the first time.

[QUIZ] — Is your credentialing software holding your practice back?

Automate Everything You Can

Setting up automated procedures wherever possible not only moves information to a practice-wide central database, it can also auto-fill claim forms with the proper information, thereby vastly reducing error potential. Automation can help the claims department:

  • Avoid duplicated claims
  • Confirm patients’ current plans and benefits
  • Automate demographic information
  • Enable easier, swifter payer authorizations
  • Organize coding and modifiers to pre-populate claims correctly
  • Flag potential claim problems before submittal

Submit Claims on Time

Untimely claim submittals represent a large portion of denials. In a busy practice struggling to keep abreast of payer changes, updated coding requirements and, perhaps, staff training, some claims can fall through the cracks. Furthermore, tracking denied claims and re-processing them within the given deadline can become a never-ending battle against the clock. Setting up automated reminders in your system can alert your staff to priority claims and get them out the door before it’s too late.

Does your software automate your claims process?

Make Sure Providers are Credentialed and Privileged

Of all the complexities of receiving patients and rendering proper treatments by the qualified staff, credentialing and privileging may present the most difficult challenge. Yet, contracts and government payers will quickly deny claims if the provider’s credentials and enrollment have yet to be verified. Credentialing in-office without a competent electronic application can take weeks or even months to complete. Your practice should deploy a system to streamline the credentialing process. Alternatively, you might consider outsourcing that part of the practice management to a provider already set up with the tools to keep your staff credentials and continuing education up to date.

Connect with Payer Systems

Medical IT providers continue to develop innovative solutions to assist practices in navigating the increasingly disruptive demands of commercial and CMS insurers. These invaluable applications and services can establish an electronic account connection between your practice and all the participating payers. Once joined, your enterprise can practically eliminate paper claims and all the errors attendant upon them. Claim denials can become far more transparent and more readily appealed and adjudicated.

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By implementing a few technology upgrades, your practice can wrestle down the number of claims unnecessarily denied. With automation, easy credentialing and direct payer connections, your claims should all go out clean and come back paid. Although medical IT can’t guarantee a perfect record of claims acceptance, it can certainly reduce the denials and subsequent write-offs to the lowest levels possible.

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