There are few things as annoying for physicians and their staff as having a claim denied. This is especially true when it was denied for reasons that could have been avoided if the proper medical billing processes were in place. However, even the best of oversight may not prevent all denials from occurring, having the proper claim denial management in place is so important.

Unfortunately, many practices do not have the proper claims denial management process in place. When you consider that about 60% of claims that were denied are not re-submitted for a variety of reasons, it shows how much revenue is being lost when responding to denied claims is not pursued.

What follows is how you can incorporate denied claims into your medical billing services, so that your practice can maximize its opportunities to increase revenue.

Find the Cause

One of the first steps that should be taken when a claim is denied is to find out why it happened. There are many different reasons why a claim is denied which includes the following;

- Errors in Pre-Authorization

- Terminated Insurance Coverage

- Incorrect Information

- Invalid Codes

- No Medical Necessity

- Duplication and More

You may find that a pattern of similar errors is taking place which can then be identified and addressed to help you get more claims through the process.

Hire an Expert

It’s generally better to have denial management team to handle all the claims, denials, and actions that have been taken. This narrows the number of people working on claims and makes it easier to track the progress overall.

Keep Track of Denials

Every denial that occurs should be tracked and include all information, starting with the insurance company, the details of why it was denied, the amount, individual claim number and service date, and how many times it has been resubmitted. This will help you identify trends in denials so that action can be taken. Plus, you can see if the number is going up or down and whether resubmissions have been successful.

Improved Technology

Unfortunately, many practices do not keep up with the latest software which contains the latest information. You can help address this by assessing patient eligibility from the moment they check in. Plus, you can tracks claim denials, brings up full patient information, and even file for appeals.

Putting in effective denial management services means that you are addressing an important revenue stream. You can help cut the number of denial claims made, track the reasons why it happens, and be proactive in finding solutions that work.

Of course, the best way to address denials is to hire a third-party medical billing services company that has the reputation, expertise, and advanced technology to address potential denials before they occur. That way, you can spend less time on denials and more time with your patients.