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5 Easy Tips to Prevent Claim Denials ! Everyone Must Know ✅

Many medical practices lose a great deal of money to claim denials and rejections. Denials and rejections have a huge financial impact on any practice. Here are 5 Easy Tips to Prevent Claim Denials.



5 Easy Tips to Prevent Claim Denials


1.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.

2.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.

3.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.

4.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.

5. Be thorough

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

  1. Provider progress notes
  2. Provider orders
  3. Nursing notes
  4. Pathology reports
  5. Consultant notes
  6. Lab reports
  7. 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.


Why are So Many Medical Claims Denied?The Untold Secret🛑

Medical billing claim denials can significantly slow down cash flow. That is why it’s extremely important to identify the causes of denied claims and prevent them in the future before they occur.

Denials can be hard and soft. Hard denials cannot be corrected; they have to be written-off. Soft denials can be corrected and the claim resubmitted.

Here are the most common errors that can result in a denial of your medical billing claims.


Incomplete or Incorrect information

Even if a single field is left blank or there is an error in it, the claim can get denied. Most denials are a result of incorrect information, such as incorrect name, gender, DOB and insurance ID. Other incorrect provider information may include address, name, contact information. Incorrect insurance provider information often includes wrong policy numbers or addresses.

Duplicate billing

When a claim is submitted for a procedure that has already been paid for or reported, it is considered ‘duplicate billing’. Such bills may make it seem that the patient received two identical services on one day, which is wrong.

Not covered by the payer

Your medical billing claim may be denied because the procedure is not covered under a patient’s current benefit plan. This can be avoided by checking insurance eligibility details or by calling the insurer before providing services.

Filing time limit exceeded

Most payers need that your medical claims are submitted within a limited time period. Delays can cause claims to be rejected or denied. Reworking denied or rejected claims for incorrect information or inaccurate coding can cause delays. So, it is important that the coding and billing are done accurately the first time. This is why many practices have now moved to outsource their medical coding and billing to responsible, professional medical billing companies that specialize in coding and billing.

To make the most of speciality billing, such as pain management billing and coding and behavioural health billing services, call Emerald Health at 855-650-9906 Today!

How Billing Audits can help you recover Lost Revenue?

Healthcare billing involves a large number of people and processes as well as a high level of expertise to make it work well. Not all healthcare providers have the resources to do it efficiently. So let’s take a look at How Billing Audits can help you recover Lost Revenue

Healthcare billing audits can help you understand where you are going wrong and losing money. Billing audits often show the following.

  • Missing commitment to follow processes
  • Lack of results focus
  • Lack of organization
  • No genuine teamwork
  • Lack of commitment to use resources in billing and revenue cycle
  • No commitment to customer service
  • Missing revenue

The above-listed items make billing complicated. Insurance companies are like constant adversaries to a positive outcome. Audits of medical billing show that missing revenue can range from anywhere between 15% and 50%.

If your in-house billing costs 5% of your revenue but you’re missing 20%, then your billing cost is actually 25% of your revenue. On the other hand, if you outsource your billing process to professional service at 8% of your revenue and they can recover 100% of your revenue, your billing cost is only 8% of your revenue.  Which option is better for your practice?

Billing audits involve running reports and interviewing your key personnel. Assessment of your processes and contracts is important too. A comprehensive detailed audit report would include all aspects of your practice along with findings and recommendations. The insights from these audits can make your practice more efficient and productive. This is how billing audits can help you recover lost revenue.

To learn more, call one of the best medical billing companies in Massachusetts, Emerald Health at 855-650-9906 Today!


3 Highly Effective Tips for Underpayment Recovery

Healthcare practices and organizations lose billions of dollars in lost revenue each year in the form of unpaid and underpaid medical claims. You do not get paid for around 5 out of every 100 patients you provide services to. As the amounts add up, it delivers a heavy blow to the financial health of your practice. Increasing patient responsibilities and the difficulty in collecting payments are becoming a troubling issue for healthcare providers. It is critical for any practice to ensure that you are able to collect what you deserve from your payer contracts. It is very difficult to actually process the payments in the facility or during the practice. Here are the 3 Highly Effective Tips for Underpayment Recovery.

3 Highly Effective Tips for Underpayment Recovery


1.Get it Right, the First Time

Accurate coding and proper billing procedures can improve your success rates the first time around, reducing the likelihood of underpayments. Trusted billing and RCM services, such as Emerald Health, ensure ongoing training for billers and coders to ensure the best results for your practice. It will also reduce your excess stress in the revenue management process.

2.Examine Contracts and Renegotiate

An experienced revenue cycle management service can assess your contracts to help you decide whether you need a contract renegotiation. They will help you review everything from fee schedules to patient expense estimations, for each payer. It will give you additional control over the revenue process. It is one of the Highly Effective Tips for Underpayment Recovery.

3.Recover What’s Owed

Since we know that underpayment is an issue, and RCM service can undertake an underpayment recovery project for you. Such a project would include an analysis of your unpaid and underpaid claims and identify recovery opportunities. These claims can then be worked upon to recover what’s owed to your practice.

These are some of the Highly Effective Tips for Underpayment Recovery. To learn more about how medical billing companies can help you with underpayment recovery, call the medical billing specialist, Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Is it Risky to have Credit Balances in Medical Billing?

In medical practice, credit balances occur when improper payments or adjustments are made that exceed the related posted charges. Physicians and practices often face this problem due to the complexity of billing and payment processes.  Le’s see Is it Risky to have Credit Balances in Medical Billing.

Credit balances are not really an asset for practice since they belong to the patient or the state. In fact, they expose the practice to several business and financial risks. This is why credit balances should be addressed with an effective Accounts Receivable (A/R) solution.

Risks with Credits Balances

If you have credit balances on your books for too long, you are burdened with the responsibility of resolving the balance, audits and other costly risks, such as

(i) Billing fraud

(ii) Misstated profits

(iii) Medicare penalties

(iv) Wasted time and processing costs

(v) Lost billing opportunities

(vi) Loss of goodwill with patients

Causes of Credit Balances

Most credit balances do not reflect what is actually owed to payers by providers. Credit balances often arise from the incorrect posting of allowances, duplicate payments, and overpayments by patients and payers, and miss-postings.

Addressing Credit Balances

A good revenue cycle management service can deliver help your practice eliminates credit balances and create a strategy for managing them in the future as well. This can be accomplished with –

(i) Regular account balance audits

(ii) Timely refunds to the rightful owner

(iii) Managing Government and commercial payer timelines

(iv) Following up with payers to check if the payment can be offset from future payments depending upon the case

(v) Managing disputes and appeals

This will give you a basic idea of is it risky to have credit balances in medical billing. learn more or to take advantage of one of the top medical billing companies and family medicine and specialty billing services, such as neurosurgery medical billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.