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28 October
2018
By admin2 | 0 comments

5 Easy Tips to Prevent Claim Denials

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.

Catch data entry errors

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.

Verify referrals on the front end

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.

Understand the difference between rejected and denied claims

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.

Know your carriers

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.

Be thorough

Don’t forget to include the following while appealing a claim.

  • Provider progress notes
  • Provider orders
  • Nursing notes
  • Pathology reports
  • Consultant notes
  • Lab reports
  • Any other documents that support the appeal

To learn more or to take advantage of the top specialty medical billing companies in Massachusetts, such as pain management billing company or behavioral health billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today. Emerald offers a free revenue cycle assessment and phone consultation. With A+ rating, Emerald Health helps small-to medium-sized medical practices improve their bottom line.

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