More than 3 of 4 healthcare leaders agree that claim denials are their major challenge. We have heard the horror stories DME providers tell of denied claims. Maybe you have a similar story of your own. The good news is that most claim denials are avoidable and as the old saying goes: “An ounce of prevention is worth a pound of cure.”
With a 30% rate of claim denial, there are many challenges for small and growing DMEs/HMEs. Claim denials are a time-consuming and complicated process that prevents timely reimbursements. Given that denial rework can cost $118 per claim, it can negatively affect your cash flow and bottom line. With just little time and effort, you can reduce your claim denial rate to be well within the industry standard of 5% to 10%.
Verify insurance eligibility prior to claim submission
One of the most common reasons for claim rejection is patient insurance ineligibility. Most claims are rejected or denied due to insufficient patient information, typically due to incorrectly filling or outdated medical information. To verify patient insurance eligibility, the medical administrative staff should pay particular attention to collecting accurate and complete data during both patient registration and appointment scheduling.
Have a data-driven approach to streamline the denial management process
Creating an efficient claims management workflow is critical to improving the efficiency of your denial management strategy. Keep track of your denied claims to prevent the serious repercussions that claim backlogs can cause. Unless they are regularly monitored and verified, it can be very challenging to keep a record of and track denied claims. Keeping track, highlighting and identifying the primary cause of the received denial can be instrumental in denial management. Running ongoing aging receivables (AR) reports and denial reports weekly and monthly can help you collect valuable data. Data can help identify the patterns of denial and whether it is eligibility, codes, or something else that can be proactively addressed. Leveraging the latest tools and technologies in electronic claim submission can help DMEs/ HMEs to monitor rejected and denied claims that need urgent attention.
File claims on time
A simple way to reduce claim denials is to post charges daily. Each payer has its own time limits and requirements on claims submissions. A simple oversight or a backlog in the office can cause missed deadlines. To prevent this risk, make sure you file charges at the end of the workday. Waiting too long after the service can lead to claim backlogs and improper management. Therefore, developing a process to ensure payer deadlines are met and the claims have been received will help decrease claim denial rate.
Prevent and Manage Claim Denials Today
Claim denials continue to be a problem and denial prevention starts with an efficient front-end billing team. However, with most of your team already overworked with patient scheduling, adding more tasks can be a burden. Outsourcing your front-end billing to professionals can help you enhance the patient experience, mitigate claim denials, and ensure correct claim submission.
Analytix Solutions has close to a decade of experience working closely with small to mid-sized businesses. Our extensive experience with outsourcing, combined with our low operating cost model, flexibility, expertise, reliability, and integrity, resulting from experience, uniquely positions us in the market.