The medical sector is constantly evolving and being updated. Some changes are made by the regulatory bodies, some by insurance providers, and others result from technology and the increasing amount of research. All of these changes make it necessary for medical practices to be on their toes. If your practice slows down the pace of change, it might be left behind, losing clients and lowering your revenue.
Denial is a term used to describe a medical claim denied by the insurance provider. It can point out potential issues in your practice that you should look into to avoid further problems and run-ins with the regulatory bodies. Health insurance providers will deny claims for a reason.
Here are some tips for handling denials in the best possible way.
1. Code to High Levels of Specificity
The more detailed the claims information, the easier it is for a claims processor to understand. If your client has been diagnosed with lung cancer after a CT scan, it would be better to include their biomarkers and other lab results in the claim.
Find a professional coder to help you make the best use of data and information to get the benefits you need. They can help you determine the coding strategies to help you avoid denial of claims. Look for a coder with a good reputation and a solid list of references and testimonials.
2. Follow the Reporting Guidelines
Some insurance companies require that you report other treatments you do as well. Some insurance providers include homeopathic therapy, chiropractic, or acupuncture in the same category as traditional medicine, even though no medical literature supports these practices. Other insurance providers allow you to report this category in your medical practice. Follow your insurance provider’s guidelines and be aware of what you are reporting.
Consider signing up for a medical coding certification course. They will help you understand the guidelines and help you get reimbursed as fast as possible. It will help you get organized and work more efficiently. It will also help you explain your reasoning if someone from the insurance company comes to audit your claims.
3. Prepare All Necessary Supporting Documents
Electronic medical records should be in place, with a copy of all records and billings. Ensure you have all the supporting documents that you need. In many cases, insurance providers will deny claims when information is missing or incomplete. If you are missing a piece of the puzzle to complete your claim, they might deny it.
The best denial management companies can help you deal with these denials in the most professional manner possible. These professional companies can help you maximize recovered revenue.
4. Remind Patients of Their Responsibilities
Patients should know that they have responsibilities in case they are involved in an insurance claim. They need to provide all the correct information to you and cooperate with your billing staff. They also need to report any changes in their condition or treatments or contact you if they do not respond or react as expected to a particular medicine.
Make copies of your insurance policies and put them up for patients needing them. If a patient does not have insurance, make sure you have some means of recording their treatment information.
5. Update Your Billing Practices
You should be wary of your current billing practices. They might not be in your patient’s or the clinic’s best interest. Consider updating your software applications, or even hire an experienced professional to help you update and perfect them. Look for IT professionals who specialize in medical billing and coding. They can find flaws and errors that you might have overlooked.
Recent automated solutions can help you manage your practice and improve your efficiency. Use these solutions to manage your scheduling, claims submission, and accounting. They will help you keep track of all cases handled by the staff, giving you a better overview of how well your practice is running.
Most denials are minor and can easily be managed with an effective denial management solution. Take some time to improve your billing and coding practices to make your practice more competitive and efficient. A few simple steps can help you avoid unnecessary stress and save you a lot of money in the long run.