How often have you evaluated your healthcare organization’s claim denial rate? Well, if it is anywhere above four percent, it’s time to rethink your denial management service strategy.

According to the latest report by the Medical Group Management Association (MGMA), Hospitals with a denial rate of less than four percent have better financial health than their counterparts with higher claim denials. What’s more, research indicates that 33% of Hospitals are in “Danger Zone” with 10% Claim Denials, in the face of the global pandemic.

Some of the common reasons for claim denials include manual data errors, oversight of critical data inputs, late submission of claims, and these seemingly minor errors that may severely impact the financial health of a healthcare organization in the long run.

This blog outlines the top reasons for claim denials and killer strategies to lower denials

1. Incorrect or Incomplete Claims

This is one of the top reasons for medical billing service claim denials. Oversight of critical claim-related patient data input could lead to insurance denials at large. Other common reasons include challenges with eligibility verification, prior authorization and missing claims respectively. Hospitals and Practices are adopting billing automation software technologies to mitigate errors and improve data accuracies.

Ensure that your medical billing management team fills all the required fields with accurate information. Your internal medical billing team can cross-verify some of the possibly missing fields that include numbers and other essential data before submission.

2. Late Submission of Claims

The time limit for claim submissions varies with Payers and may also be revised. From 30 days to as long as two years, Insurance providers have a different set of guidelines for timely filing. Late submission claim denials can largely be prevented with medical billing automation and other techniques that help streamline the workflows. It is essential that you keep tabs on the timing windows of different Insurers

3. Lack of Clarity

The more specific the coding, the lower the rate of denials that get rejected due to a lack of specificity in medical coding. Ensure that you code to the highest level of specificity and your medical coding services team is well aware of truncated codes so they can automatically correct these codes before submission. As per the Health Insurance Portability and Accountability Act (HIPAA) code set standards, the Centers for Medicare and Medicaid Services (CMS) has announced the need for codes with the highest specificity.

4. Illegible Paper Claims

Though a majority of claims are using automated billing software to reduce manual errors, some of the processes require manual intervention. Manual submissions may have unclear forms that make their way to unfavorable claim denials. Ensure that these claims go through another level of verification to have the forms readable.

5. Claims Don’t Meet the Required Criteria

Claim denials are highly variable by insurers. Some Payers may demand extremely well organized claim submission forms and may require more accurate data that are mandatory before claim submission. Pay special attention to such scenarios; create a focused strategy and have a checklist that you need to go through for these payers. Analytical data will also give you insights into the nature of the most frequently denied claims that you can overcome in the future.

Also Read:

6 Key Strategies to Improve Denial Management Services in Healthcare Revenue Cycle

---

Top Ways to Improve Denial Management Process for Accelerated Revenue Cycle Performance

---

Automating Healthcare Revenue Cycle Management Services for Faster Reimbursements

---

8 Questions to Ask Before you hire a Medical Billing Company

---

10 Reasons to Consider Outsourcing Healthcare Revenue Cycle Management Services

---

Our 4Clover Approach to Denial Management Services

At SolvEdge, we have designed our unique 4Clover approach to reduce denials, improve cash flow, and ultimately accelerate your revenue cycle performance. The four-step process to Analyze, Strategize, Discover and Implement ensures a holistic approach to your revenue cycle process that creates a long-lasting impact.

To learn more about how our denial management services can help drive your healthcare organization’s revenue cycle performance, talk to our team.