The two main concerns of healthcare providers are; providing the best care services to their patients and getting fully paid for their care services. Despite advances in the medical field due to the introduction of innovative technology, hospitals are still indulged in the complications of medical billing services due to ever-evolving payer’s policies and regulations. It hinders them to get fully paid and in a timely manner.
Hospitals and health systems acknowledge that claim denials are a significant contributor to the financial challenges. Therefore, in this article, I have provided the top 4 proven tips to empower medical billing services that result in the least claim denials and maximum revenue on return.
- An Analytical-Based Approach:
A single-digit denial rate means that a large hospital is leaving tens of thousands of dollars uncollected due to claim denials each year. Medical billing services is a procedure that includes many touchpoints, that provide ample room for errors. As a result, there are a lot of risks that can cause claim denials and rejections. If administrative staff would attempt to control claim denials reactively or in an isolated manner then it will result in inefficient use of resources and a continuous claim denials issue.
Therefore, medical billers should strategically address denials with an analytics-driven approach. On the other hand, they should prepare advance plans to execute denial prevention. For this purpose, medical billers should realize the key areas that are more prone to errors and where inefficiencies occur mostly. Usually, common billing errors originate in the following key areas;
- Registration data entry.
- Pre-authorization and medical necessity.
- Eligibility and benefits checking.
- Clinical documentation.
- Medical Coding.
- Claim editing.
Errors may also occur due to other regulatory requirements in the overall healthcare revenue cycle management. By taking a big picture approach, medical billers should examine, analyze, and identify risks in the above-mentioned areas to mitigate risk potential. In this way, they can streamline the medical billing process that could result in fewer claim denials.
- Pre-Plan For Denial Prevention:
According to a recent analytical report, it has been revealed that approximately two-thirds of claim denials are recoverable, while 90 % are preventable. Although, preventing claim denials required a new level of visibility and knowledge about the major factors that contribute to claim denials. It also requires expertise and experience of medical billing specialists who can align changes and workflows to customized revenue growth.
The primary attribute of professional medical billing services is to determine patient coverage and ensure clean patient data. There should be a front desk that can directly communicate with patients and capture verified information. On the contrary, most healthcare practitioners follow the culture to thrust these responsibilities upon the shoulders of backend staff. The days are gone, and it is inevitable to start proceeding with the protocols of healthcare revenue cycle management from the step of pre-registration. It will help medical practitioners to ensure the accuracy and validity of the patients’ information right from the beginning of their visit to the hospital.
In this way, accurate information would flow down to the medical billing department and reduce the chance of medical claim errors.
- Identify Insurance Eligibility And Pre-Authorization:
It is the first-line defense to identify eligibility at the very beginning of the medical billing services procedure and authenticate pre-authorization. When the front office staff has accurate patient financial information upfront then hospitals experience fewer claim denials and rejections. The front desk staff must also realize whether the patient is self-paying or not right at the point of registration.
If the registration staff has the ability to verify if the patient is covered by Medicaid or Medicaid, as well as realize Medicaid/Medicare HMO coverage that is often ignored by the medical billing professionals. Providers can also secure payment with the help of Medicare billing while reclassifying such patients as covered.
Another important step to prevent excessive claim denials is pre-authorization and medical necessity management program. Many hospitals deal with the difficulties involved in pre-authorization and medical necessity payer requirements that lead to costly provider rework, resubmissions, denials, and write offs. Most importantly, medical necessity is the common cause of most of the claim denials. It is essential to ensure patient services as a medical necessity at the point of registration to prevent further payment issues down the road.
- Perform Denial Analysis:
It is important to perform a thorough denial analysis to prevent your medical billing services from further issues that can lead to denials. Medical billers should access nuanced and actionable insights to inform more efficient processes and compare performance metrics with hospital peers to gain context about the quality measures of their denial management services.
Medical billers should tend to use claim management solutions to organize vast amounts of data. Unfortunately, most of the healthcare organizations lack the ability to realize the true value of big data. Although, when data is scattered at multiple locations then it becomes nearly impossible to unlock insights to support strategic decisions. Therefore, healthcare practitioners must realize the revenue cycle analytics that can add real-time visibility into your overall revenue cycle management system.
Conclusion:
Healthcare practitioners should employ these strategies to experience significant improvement in denial rates. Healthcare professionals should equip themselves with more complete and timely data, medical billing staff to immediately identify where performance is lagging and catch the root cause of issues. Practitioners should also track down which specialties, departments, physicians or payers are contributing most to the claim denials. In order to resolve these issues, medical billers should organize data to empower intuitive decisions to drive positive results.
If you are encountering disruptions in your revenue cycle management due to unexpected errors, scattered and insufficient medical billing solutions. Then outsource medical billing services to Medcare MSO. We are a US-based medical billing company that helps practitioners to combat revenue crises and drive productive results. Contact us! To consult with our medical billing experts to improve your revenue collection procedures.
I’m a 20-something stay-at-home mother and wife. I have an amazing husband, a beautiful daughter, two loving dogs, and a lazy cat. I wouldn’t change my life for anything! I love to read, listen to music, cook and blog!
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