How to Prevent Claim Denials and Increase the Reputation of Your Practice

When it comes to filing insurance claims,  you don’t want to end up getting a denial when you are trying to process insurance claims.  Your patients rely on you to take care of their insurance claim referrals so that they don’t have to worry about the paperwork.  Where you are a Hospital Revenue Cycle manager or CFO who outsources your revenue cycle functions, we can help.

First, let’s talk about why claim denials occur. This can happen for a variety of reasons. Perhaps there is not enough information in the form to make a decision from the insurance company’s perspective. The information provided may not match the client’s previous information. Perhaps there was an address change or other demographic information has changed since they applied for the insurance. Whatever the case, get the paperwork right first. Then we’ll talk about the other reasons you might be denied and how to avoid denials.

How Do I Avoid Having My Claim Denied?

There are a number of reasons claims might be denied besides having the wrong forms or having information that is outdated or irrelevant.  It is important that you understand the reasons so that you can present your claim in such a way that the insurance companies know it is a valid claim.

5 Tips to Help Avoid Denials

Here are some tips to remember to avoid denials when you file patient insurance paperwork:

1. Verify eligibility. It is important that you check to make sure your patient qualifies for the insurance in the first place to avoid it being automatically thrown back to underwriting or tossed out as an unqualified claim. Make sure the patient is covered for the medical condition that you are applying for on their behalf and get any questions answered at the onset to avoid service and payout delays.

2. Be specific about the medical condition. Insurance operates on a very specific assumption: that you are covering the exact illness or medical condition and under the circumstances that are covered by the insurance. Be sure this is accurate before starting a claim.

3. Be prompt. There’s nothing worse than missing a deadline. This is especially critical with insurance claims. The insurance claims are so specific that, by law, if you are even 1 minute past the deadline,  you are not covered and the policy will be invalidated.

4. Learn from former denials. If your claim was denied in the past, find out why it was initially denied and learn from that. Call the insurance company or do your own side research to determine the reason, then make notes so that you will not make this mistake in the future.

5. Talk to experts. When you are unsure of how to answer a company form for an insurance or billing claim, ask an expert with more experience so that you will get it right. You simply don’t have time to waste when your client is needing help with an insurance claim. Do your homework and visit with an insurance or medical billing specialist.

Where We Come In

When talking about insurance claim experts, that’s where we come in.

We cover a number of different services and solutions that allow you to streamline your insurance systems and administrative tasks so that you have fewer denials and more successful claims for your patients. That’s what will keep your customers coming back time and time again.

By decreasing the number of denials you get from insurance claims, you automatically increase your revenue by establishing a system that works and that your most valued customers can rely on. That helps improve your reputation in business and in your practice, as well as ensuring you are providing your patients with the help they need when they need it most.

Contact Us

For help regarding your medical billing services, contact us online or call 785-330-7288.

If you’re wondering what you can do to increase your bottom line, look at your billing system first. Is it working the way it should work for your practice? If not, the problem could be with your billing and insurance. Call us first and you will see that we put our money where our mouth is.