How to Prevent Claim Denials

Did you know that about 17% of in-network claims were denied in 2019, and about 14% of in-network claims were denied by issuers in 2018? Almost every hospital struggles with denials, and that poses a threat to the income of the hospital. Medical claims can be extremely difficult to navigate properly due to the time and costs that are involved in the process. If you are one of the many that are struggling with claim denials, follow these tips and tricks below to learn how to prevent claim denials.

1. Look Back on Previous Denials

Start categorizing and documenting all the data that you can about denials in general. The first step to stopping claim denials is understanding why you are being denied in the first place. Have your billing department set up a system to accomplish this so that you can refer to the tool to prevent them from happening in the future.

2. Specific Details

Claims are often denied due to generality, causing the insurance provider to interpret the claim themselves. Be specific by using a diagnosis code with the highest degree of specificity as possible. Make sure you complete provided information as much as you can so that your claim cannot be interpreted in a way from which the insurance company can benefit.

3. Always Verify First

One of the first things that you should do is obtain eligibility information before scheduling an appointment of any kind. Verification of insurance cuts down your number of claim denials right away because you can seek another reimbursement option before the patient has even received the care. This will not cause any extra waiting time for the patient because appointments are scheduled in advance anyways. Most authorizations come with a time window for which they are valid, so making sure that the appointment meets that timeframe is very important.

4. Timing Is Everything

If a claim is late, they are typically always denied immediately. If the hospital is extremely busy, it is easy to get backed up on denied claims. It is important to have proper safeguards in place so that claims are submitted on time. Multiple denials can be extremely hurtful, especially when expensive procedures have already taken place. The hospital should set up systems to verify that claims go out on time, and regularly monitor this process.

5. Seek Help

All hospitals and administrative departments deal with this daily. Claim denials are one of the most common lost income areas in a business. That’s why it’s so important to learn how to prevent claim denials. Working with an expert can help you identify and follow through with the process of submitting, processing, and collecting the claims. This will help you establish a system that will monitor exactly why denials are happening.  It will also ensure that they do not happen again in the future.

Now What?

As a third-party billing specialist, The Midland Group can help you with all of your claims. Our trained medical billing professionals are familiar with the tools, rules, and documents needed to submit a successful insurance claim. Contact us today or book your free assessment to see how you can maximize all potential revenue surrounding all types of claims, including third-party liability.