Medical Billing Denials: Preventing Common Errors

preventing medical billing denials

Medical billing denials not only create headaches for your practice, they negatively impact your cash flow and ability to operate.

The average medical practice sees a 5-10 percent denial rate for billing, according to the American Academy of Family Physicians.  Industry best practices call for a rate below 5 percent.

To lower your denial rate, and improve your bottom line, look out for these top five reasons for medical billing denials, according to the 2013 American Medical Association National Health Insurer Report Card.

1 – Missing or Erroneous Information

Simple technical errors can account for the bulk of medical denials.  Incorrect plan codes, wrong modifiers, a forgotten field or an omitted social security number can trigger an automatic denial.

Your practice can combat this common issue by focusing your team on denial prevention.  Develop process across the board – from patient accounting to case management and coding – to improve accuracy.

2 – Duplicates

Duplicate claim submissions for the same encounter with the same provider to the same patient will result in denials.

If a claim is denied, your practice workflow should include evaluating the cause of the denial and submitting a corrected claim rather than resubmitting the same claim.  If your practice struggles with the manpower to review each denial, an outsourced revenue cycle management service like Med3000 can help resubmit denied claims.

3 – Filing Limit Expired

Once a patient has been served, your team is on the clock to submit medical claims.  Billing deadlines can be missed, meaning your hard-earned money goes uncollected.

Your workflow processes can help to prevent these issues.  By developing practices and reminders around insurer timelines, and determining root causes of denials you can stay on top of deadlines and collect the money your have earned.

4 – Service Already Adjudicated

These denials occur when benefits for a billed service have already been included in the payment or allowance for a previously adjudicated service.

Focusing on process management will help prevent previously adjudicated charges from being resubmitted.

5 – Service Not Covered

Providing a service to your patient only to find out that insurance doesn’t cover that claim can be an unpleasant surprise to you both.

By working to improve patient data quality with your incoming patient procedures and pre-work you can prevent these denials and collect the money you have earned.

Take the time to review the denials at your practice, and determine the root cause of each instance.  Then you can begin tracking, measuring and reporting to pinpoint which issues are regularly affecting your medical billing claims.  Take a look at trends by provider, procedure, and payer.

You can also address these common mistakes, and others, by working with a revenue cycle management company.  With outsourced billing and expert consulting, professional services like Med3000 can reduce days in AR, lower your denial rate and help you collect every dollar you earn.

To talk to one of our experts about medical billing or revenue cycle management?  Contact Med3000 today.