Are You Watching Your Revenue Cycle & Medical Billing Denials?

Today, the healthcare landscape has drastically evolved. The services are accessible to all because of the implementation of medical insurance. There is no doubt that the system of medical insurance is beneficial for patients in every way.

However, the process of claiming insurance and getting reimbursed for the services provided by insurance providers can be a hectic procedure. This process gets further complicated by frequent medical billing denials.

A situation of claim denial arises when the medical claim submitted is not reimbursed accordingly. In this situation, your insurance provider refused to pay the sum for the claim you submit. It adversely affects financial health and decreases the chances of your future revenue generation.

In this blog post, we will discuss the major reasons for medical billing denials. We will also learn how you can transform the revenue cycle management by overcoming all the reasons that affect your revenue cycle.

Most Common Medical Billing Denials

Medical billing denials bring several challenges to healthcare providers. This results in delayed payments, more administrative burden, and potential losses of finances. For smooth revenue cycle management and improved efficiency, it is a must to understand the root causes of medical billing denials.

Let’s get into the most common medical billing denials in healthcare facilities:

No Insurance Coverage

One major reason for the medical billing denials is in case the insurance coverage gets expired or has not at all initiated. In this case, the denial is because the patients fail to keep the information updated or don’t take care to renew the insurance.

Such denials can be eliminated by healthcare providers if they verify insurance eligibility before the patient visits the hospital. It should be a priority to ensure that accurate and updated information is captured.

Incorrect Information of Patients

It is often found that there are errors in patient demographics. It includes errors in spelling, date of birth, wrong contact details, etc. All this can directly lead to claim denials. The main reasons for these kinds of errors are incomplete forms, any sort of miscommunication during the process of registration, and mistakes in data entry.

To minimize these types of denials, it is important to ensure a strong verification and get a strong patient registration process.

Any Sort of Missing or Invalid Information

Another reason for medical billing denials is when there is missing or incomplete information. When the information is not sufficient, like no proper diagnosis codes, no procedure codes, and modifiers, the result is claim rejections. You can utilize electronic health record (EHR) systems with various claim scrubbing tools that can help you detect and rectify all issues before you submit the final claim.

Errors in the Process of Coding

There can arise various errors like diagnosis codes inaccurately assigned, no proper procedure codes, etc. which can directly result in medical claim denials.

These errors arise because of the inadequate documentation, lack of proper knowledge in coding and no clear understanding of coding guidelines.

Therefore, it is essential to train and educate coding staff regularly. Make sure you perform regular audits to identify errors and eliminate denials.

Issues in Prior Authorization

Other medical billing denials that are prevalent in the medical billing process are related to the lack of proper prior authorization and documentation. If you as a healthcare provider fail to accurately collect information and document it nicely, the scope of errors will automatically be increased.

There must exist efficient communication channels with insurance providers, educate staff on authorization requirements, and implement robust processes to obtain and document necessary authorizations in a timely manner.

Denials Related to Medical Necessity

There might arise when your medical claim gets denied if any service or process is not regarded as a medical necessity. The major cause of denials is insufficient documentation. Healthcare providers must make sure that there is comprehensive and detailed documentation which clearly outlines the medical necessity and the services rendered. Medical necessity denials can be prevented with clear communication.

So, these were the most common medical billing denials which creates chaos within the healthcare facility.

Effective Methods to Avoid Medical Billing Denials

Get an EHR Backup System

In healthcare facilities, medical billing service providers like Eminence RCM Medical billing services providers will keep a backup server with millions of patient records and protect the information.

Today, everything is getting advanced and automated in every sector and healthcare is no different. You must have over-the-top technologies to comply with HIPAA and other government-related needs.

Proper Verification and Sorting of Details

Billing providers like Eminence RCM work closely with healthcare providers to support their administrative tasks. It includes patient registration, processing various documents, and assigning different medical billing codes.

The proper percentage of different claims against refusals must be calculated. It should be observed whether each refusal is fixed, the records are preserved diligently, and financial reports are prepared based on that. It is the responsibility of your medical billing service provider to come up with resolutions to solve every medical billing problem.

Try to Eliminate Errors in Coding

Errors in coding are becoming an increasing cause of medical billing denials after the advent of ICD-10 and frequent changes in Current Procedural Terminology (CPT) coding guidelines. The best possible way to minimize the scope of errors in coding is to hire a reliable medical billing company like Eminence RCM. We thoroughly check every claim before the final submission and the scope of missing and incorrect codes is minimized.

Be Updated on Every Change in Medical Guidelines

When you get a specialized medical billing company to manage your revenue cycle management, they ensure reliable billing processes. When you have a billing team that is constantly aware of updates in the industry, various policy adjustments, and various medical billing modifications. They are aware of various changes in insurance plans and help to ensure the smooth medical billing process.

Ensure a Detailed Inspection of Claims

In the entire medical billing process, it is not sufficient to just interact with the healthcare staff and outside parties. You must be more vigilant than that to ensure smooth functioning of your revenue cycle.

There must be various methods like sending a reminder email or calling for getting proper clarification, etc. A reputed medical billing company like Eminence RCM keeps all the policies and regulations updated.

Efforts Towards Preventing Denials

To increase reimbursements, the most efficient approach is to implement preventive measures to save time and avoid costly medical claim denial process. The best way to properly identify and categorize all the denial reasons that are encountered the greatest number of times. After that, they should be addressed by the departments.

The measures include:

• Training staff on accurate coding and billing
• Complete patient information and medical records
• Filling claims on time
• Stay updated about the changes in insurance process
• Using EHRs for easy access to latest information
• Verify insurance and eligibility before imparting service
• Monitor and analyze your revenue generation

Consider the Option of Outsourcing

One effective option to minimize the medical billing denials is by outsourcing the entire process to the experts. Make sure you choose your billing partner after proper analysis and the one who suits your requirements.

Eminence RCM is a reliable medical billing company. They have a dedicated team of experienced coders and billers. They will work on addressing all the denials in a timely manner. It will be ensured that no money is missed due to the claim denials.

Get in touch with the denial management experts of Eminence RCM!