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Denial Management and Prevention Tips for Your Medical Practice November 23, 2020

denial management

Denied claims eat away 6-8% of a healthcare provider’s overall revenue. It hampers the financial stability and the growth of a practice. Contrary to popular belief, 90% of denied claims are actually preventable. You just need to take your denial management and prevention to the next level. We’ve gathered the best tips to stop these revenue leaks: 

1. Monitor you progress.

First, assess your denial management process frequently. You need to discern what’s working and what areas need improvement. To know your progress, you need to document all wins and losses for your unpaid claims. Thus, you’ll be able to use that data to improve the efficiency of your denial management strategies. 

2. Recognize why claims were rejected.

Understanding the causes of your denied claims will help streamline the process of maximizing your revenue collections and prevent the denial of future claims. Not all of your patients are knowledgeable about when their claims are being denied by insurance companies. Thus, it is your responsibility to educate them when tackling the issue. In connection, It is also important for the overall performance of your company to be able to assist them in a timely manner.

3. Identify the most common denials and trends.

Try to identify the types of denials that are most common to your organization. Initially, each form of denial can seem like a minor issue, but when you begin to track and examine these patterns, it can lead you to the root cause of some major problems in your organization.

4. Establish Incentive Programs

To motivate and encourage healthy competition, rewards and incentives should be put in place. Your staff should have the right motivation not only to successfully appeal denials but to recognize trends, share knowledge, and have great camaraderie.

5. Expedite your Denial Management Process

Denied claims may pile up over time and it may easy to lose track, which may lead to serious problems in the future. Utilize the latest technologies and tools that help you keep track, manage, and expedite your denial management processes. 

6. Do it within a week

You need to set high standards for timeliness in processing your denied claims. An effective tracking system would lead to more efficiency and help impact all factors of your practice. If you get a rejection from an insurance provider, there must be a procedure in order to ensure that the denial is handled in less than a week.

7. Leave it to the experts

You can never go wrong in outsourcing your medical billing and denial management processes to a trusted name in healthcare. It will surely give you the financial prosperity and stability that you always desired. Specialized teams that are highly trained in handling the complexities of the insurance system are used by the top denial management providers. You’ll have more time to focus on your core competencies by outsourcing your denial management needs.

Tap Into Our Expertise

At 5 Star Medical Billing, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.

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Tips for Preventing Claims Denials November 5, 2013

claims denialsClaims denials are a source of revenue loss for many healthcare facilities, specifically for those in Ohio. Yet organizations are often unaware as to how to improve the claims submission process. This lack of knowledge can result in repeated denials and interruptions in cash flow. Plus, when claims are not appealed or resubmitted for review, it basically means that doctors are working for free. In order to ensure that payment is obtained for services rendered – and that extra time and money isn’t being spent processing denied claims, it is important for billing staff to be efficient the first time around.

Here are a couple of ways an Ohio billing service can help physicians prevent denials:

Regularly monitor submission reports to track the reason behind each denial.

Monitoring reports is one of the best ways to find problems and figure out ways to fix them – and a medical billing company can help physician practices do this. Submission reports can be reviewed monthly – or more or less often, depending on the frequency of denials at a particular practice – and billers should take into account the number of claims that are getting denied, as well as what the cause is behind each one. Some common reasons for denials include:

  • Untimely filing
  • Incorrect modifier
  • Incorrect coding
  • Missing or incorrect information

Implement policies to prevent claims from getting denied in the future.

After identifying the reason claims are getting denied, it is necessary to address those problems so that they do not continue to occur. An Ohio billing service will know the reasons claims often get denied and will work with standardized submission and resolution processes to ensure that maximum reimbursement is achieved.

At 5 Star Billing Service, we handle high claims volumes and excel in accurately coding, billing, and finding data entry errors to prevent denials. We submit claims daily to prevent untimely filing; and we ensure that our physician clients in Ohio are satisfied with our medical billing services and benefit from high-performing billing departments. Our employees have in-depth knowledge of billing and claims submission processes, and they pay attention to small details to make sure that claims are submitted error-free the first time around. This means less follow-up work for us and more on-time payments for our clients.

To learn more about medical billing services for physicians in Ohio, call 480-821-1371 or contact us online.


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