Out of all the factors that can negatively impact a healthcare provider’s bottom line, medical billing denials are among the most common – and the most frustrating. If your revenue stream and collection rates are struggling, the good news is that effective management can help turn things around. In fact, many denials are preventable if providers are proactive in addressing the root issues.
The first step in combatting billing denials is analyzing your denial reasons and volume. From there, you can educate providers and staff on correct processes to ensure accurate patient registration and charge capture, along with solid supporting documentation and coding for timely and clean claim submissions. To put this into action in your own practice, follow the three steps below:
Step 1: Focus on Prevention
When it comes to billing denials, the best offense is a good defense. Do your research to discover the root cause of your claims denials, then ask yourself how the identified denials could be prevented. You may need to engage coding experts or look over payor contracts to get answers. Additionally, consider if there are edits that can be added to claim scrubs to catch issues moving forward.
Step 2: Speed up Your Recoupment Process
Having a clear and consistent denial management process can help your team operate faster and more efficiently. Work smarter, not harder, by identifying denials and grouping them by reason and plans, then working them in bulk. Avoid snail mail routes whenever possible, opting to utilize payer portals or fax instead for faster turnarounds.
Step 3: Have an Escalation Plan
When normal appeals channels do not work, it’s critical to have a plan in place. Maintain a list of payer contacts who can assist your practice, and become familiar with your state’s insurance commissioner website and process for filing complaints.
Managing denials effectively can improve your patient satisfaction levels and dramatically impact your practice’s bottom line. Focus on the tips shared here to be proactive and strategic in the process, and if you need additional support, don’t hesitate to outsource the work or seek the advice of experts. Our door at MMG is always open, should you need support.