Many medical practices lose a great deal of money to claim denials and rejections. Denials and rejections have a huge financial impact for any practice. Here are a few easy tips to prevent and manage denials in your own practice.
Most rejections can be prevented by minimizing data entry errors. Something as simple as a misspelt name can cost you hundreds of dollars. Train your front desk staff to pay close attention to and verify all insurance and demographic information before the patient visit and then re-verify at the time of the appointment.
Many referrals are only valid for 30 days, and failure to validate or update the referral before the patient visit can cause unnecessary, expensive delays in cash flow.
You can’t appeal a rejected claim. Claims are rejected when they do not include the information necessary to determine coverage. These claims require correction and re-submission which means delays in payment.
On the other hand, a denied claim is a claim that doesn’t meet coverage criteria. These claims can be appealed but not all of them. Some denials, such as those for benefit limitations and membership issues are not appealable.
Each insurance carrier has different rules and deadlines for claim submission. Your billing staff should have the deadline, address and submission requirements information for the top 5 carriers.
Don’t forget to include the following while appealing a claim.
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