Advertisement
8 ways to prevent denials at your physician’s practice

8 ways to prevent denials at your physician’s practice

  By Michelle Crawley Ask a physician about their biggest pain points when it comes to the physician billing process, and they’ll frequently mention denials. A denied claim is a claim that the payer has processed and refused reimbursement based on one or more factors. No one wants their medical payments to be denied because spending time appealing a denied claim and sending it back to the payer for processing increases administrative costs and delays cash flow. That’s why it’s important to prevent denials in the first place. While you certainly want to work any denials that do occur, it takes more time to fix a claim than it takes to get it right the first time. Etiology of denials There are several common causes of claim denials, including: ♦  Ineligibility ♦  Procedure not medically necessary ♦  Preauthorization required ♦  Provider out of network ♦  Incomplete information ♦  Incorrect patient information (sex, name, DOB, insurance ID number) ♦  Incorrect provider information (NPI, address, name, contact information) ♦  Incorrect insurance provider information (wrong policy number, address) ♦  Duplicate claims ♦  Improper coding / issues with ICD-10 ♦  Untimely filing Fixing the problem It’s important to have internal processes in place that can find and correct mistakes before a claim is submitted. Consider investing in automated systems that help to flag potential errors before the claim leaves your office. A revenue cycle management (RCM) service can handle all aspects of the billing process. When properly integrated with an electronic health record (EHR) or a practice management (PM) system, the process can be streamlined and administrative mistakes can be reduced from patient...
Page 1 of 43212345...Last »
[ HIDE/SHOW ]