Reduce Your Denied Claims -- To do List

ANNAPOLIS, Md. - Feb. 25, 2015 - PRLog -- If there was ever a question in your mind as to why you are receiving an over abundance of denied claims, here’s your answer.  According to this recent study by BMC Health Services, “$375 billion annually is wasted on billing and health insurance-related paperwork.” (http://www.pnhp.org/news/2015/january/375-billion-wasted-on-billing-and-health-insurance-related-paperwork-annually-stud) Without a doubt that figure is astounding, but for me – Sadly, not nearly as hard to believe as it should be.

With over 20 years in the industry I have been a witness to the increased responsibility placed on the physician; Interacting with payers, filing claims, obtaining prior authorizations, managed care administration, and the list goes on. Which is precisely why Physicians Business Advisors and Associates (PBA) compiled a list of the most commonly made mistakes below. When followed we see an average of less than a 1% claims denial rate.

Is your practice’s denial rate above the national average of four percent? If it is, it’s time we start looking inward at your office’s processes. Manual errors, input oversights and timing issues could be causing more denials than you realize. Tighten up your billing approach and follow through. Your money is worth an extra look.

Claim is Not Specific Enough
It can’t be said enough: Coding to the highest level of specificity is the best way to reduce denials. A diagnosis must be coded to the absolute highest level for that code, meaning the maximum number of digits for the code being used. You may have a four-digit diagnosis code that needs to be five digits to be accepted. Send off four and you may get back a denial. If you have billing company in place - facilitating a dialogue between your billers and coders is essential. Weekly visits are recommended.

Claim is Missing Information
If your staffers leave certain encounter data out of a claim, and it could come back to haunt you in the form of an insurance denial. A detail-oriented payer will notice omissions and count such errors as reason enough to deny a claim. The Ohio State Medical Association (http://www.osma.org/tools-resources/reimbursement-payer-a...) listed the most common pieces of missing information to be important date specifics: date of accident, date of medical emergency and date of onset. Make sure your employees fill in all required areas on your claim forms. Have your billers double check commonly missed fields, like those above and the patient subscriber number, and make sure such errors are rectified before your claims are transmitted.

Claim is Not up to Payer Standards
Some of your payers may be more sensitive to the claim issues listed above than others. And though every claim should be perfect when it’s shipped off, knowing which payers are pickiest helps you send those insurers the most flawless claims possible.

Group your transactions by payer.
That allows you to categorize and pinpoint which insurers are consistently denying claims for reasons like those previously listed. Then make certain the claims you submit to your most finicky trading partners are as clear and precise as possible.

Claim is Not Filed on Time
Timely filing denials are probably the most frustrating kind. But since every office operates on its own filing deadline schedule, it can be easy to miss a timing window if you’re not being careful. Have your staff billers keep a list of general payer deadlines handy. When possible, track and document each payer’s receipt of claim submissions. Sometimes claims are unfairly denied for timely filing, like when a claim was submitted properly but not received by the insurance carrier within the window. Hold payers accountable for their timely receipt of your transactions.

Claim was Denied… Now What?
Appeal! PBA has found that only 35% of providers appeal denied claims. Since payers frequently make mistakes and deny claims in error, that percentage should be much higher.

Inspect every single denied claim to make sure it’s correct and develop a denial management system in your practice. Task an employee with appeal duties.