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How to Decrease Your Practice Denial Rate

January 18, 2016 | 12:00 pm
Published by | Krunal Popat

One of the most annoying aspects that affect the revenue of healthcare providers is when claims are denied. To run an effective denial management system, the first step should be the realization that a certain percentage of denials will occur for one reason or another.

However, there are plenty of good reasons to institute the most effective system of catching potential denials before they can occur. By following a few simple common sense steps and putting forth a little more diligence, health care providers can significantly lower their denial rates.

Get More Prior Authorization

A simple, yet very effective way to avoid certain types of denials is getting prior authorization for every service that is required. In this manner, your staff can work ahead of time to ensure that each patient has the insurance available so that the service can be delivered with confidence of being covered.

Determine the Eligibility of the Patient

You should have your staff go over the eligibility of each patient so that their coverage and benefits are known before a claim is made. This will mean asking patients if their coverage has changed since their last visit and the ability to verify their current coverage.

Coding Errors

One of the biggest reasons that claims get denied is simple coding errors where and outdated or wrong code is used to identify the service instead of the correct one. With the recent ICD-10 transition there will be a rise in the tendency to make additional errors. So, the new codes will need to be easily accessed and double checked to avoid such mistakes from occurring.

Double Check before Sending it In

Basically, you will need good proofreaders in order to avoid simple mistakes that would otherwise result in more denials occurring. Although it may not be possible if your office only has a very small staff handling these issues, but proofreaders catch more mistakes if they are not the ones who originally filled out the forms.

Putting in an effective denial management program can help your office reduce mistakes and other issues which causes rejections to occur.