Medical Claim Denials: Causes And Solution To Grow Practice Revenue

Medical claim denials can be burdensome for healthcare providers regardless of how or why they occur. And studies have revealed that they are happening more often each year, with hospitals experiencing a 23 percent increase in frequency between 2016 and 2020. Hence, managing claim denial in healthcare organizations is essential in growing their revenue cycle management.

Clean claims of up to 99 percent are possible with the correct approach and services. Medical providers with a higher percentage of clean claims receive reimbursements faster and are less likely to receive no payment. Focusing on preventing claim denials in the first place can help a medical practice reduce overall costs and increase revenue.

Claim Denials: Causes And Solutions

When patients have insurance that pays for treatments, healthcare providers have to file claims with insurance companies to get reimbursed for their specific services. However, insurance companies may deny incomplete or incorrectly filled out claims.

Medical practices should aim for a clean claims rate of 95 percent for an effective revenue cycle. You may boost the productivity and profitability of your medical business by keeping a high clean claims rate.

So, how can you avoid insurance claim denials and keep a high clean claims rate in your practice?

• Timely Filing of the Claims. Each insurance company has a separate claim deadline. You can avoid late filing fines and denials if you can charge all completed claims daily. Most insurance companies will not accept claims filed after the deadline, so it’s also worth the extra money to get claims billed on time.
• Incorrect Patient Details. Tons of claims are denied right away by insurance companies because either the patient’s name is misspelled, the ID number is wrong, or other identifying information is incorrect. That’s why any verbal information should be printed out and checked for accuracy by the patient.
• Analyze Previous Denials’ Causes. Understanding the most common reasons for medical claim denials is critical to your denial management strategy. This can be accomplished with the use of high-quality denial management services provided by online health management platforms. The system can enable automated procedures that detect typical causes of denials and provide solutions to your healthcare organization. Medical providers can increase their clean claims by effectively addressing likely causes of denials.
• Introducing Automation. Automation is here to remain, and embracing it can help increase revenue in your practice. The finest platform automates the update of procedures and codes, incorporates project management capabilities, and optimizes the processes required for both claims and billing.
• Insurance Verification. The second most common reason for rejecting claims is a lack of coverage. Verifying treatment coverage beforehand is a crucial step toward enhancing your denial management process. With the right digital tools, you can now automate insurance verification. Your front-line personnel can effectively verify coverage before care is provided, protecting both the physician’s time and money.
• Improve the EHR Notes’ Quality. Start by collecting accurate, clear, and detailed notes in your EHR system if you want to increase the frequency of clean claims. The more details are included in these records, the easier it will be for coders to analyze those notes and code any applicable procedures or other services for each claim.

Preventing Claim Denial-PatientMD Can Guide You

PatientMD specializes in making your medical practice function more smoothly while also improving your revenue cycle management. It is an AI-driven digital health platform providing patient engagement and recruitment solutions. It verifies all your claims are clean and error-free before submitting them, reducing claim denials and generating constant and positive revenue flow for your clinic.

To know how seamless your payments management processes could be, text us now at +18727048154.