Denials can be divided into two categories: hard and mild. Hard denials result in lost or written-off evenue since they cannot be remedied or overturned. Soft denials are brief rejections that might be overturned if the provider amends the claim or provides further details.
As with your patient’s health, prevention is key to avoiding the Prevent Medical Billing Claim Denials that have a serious negative effect on your bottom line. Payers normally don’t pay you any earlier than necessary, and if you offer them a reason to reject your claim, you may incur an additional wait of two or more valuable weeks. Additionally, this does not account for the time lost in investigating and resubmitting claims that contained errors.
In order to speed up your payments, Fast Billing Solutions can assist you swiftly, rectify and resubmit claims where necessary and, when necessary, has learned how to reduce the likelihood of denials in the first place. When your payer contracts have already resulted in rate discounts, this is essential to ensuring that even Payers normally don’t pay you any earlier than necessary, and if you offer them a reason to reject your claim, you may incur an additional wait of two or more valuable weeks. Additionally, this does not account for the time lost in investigating and resubmitting claims that contained errors.
Top 5 List of Denials In Medical Billing You Can Avoid
These are the most common healthcare denials your staff should watch out for:
1. Missing Information
If even one mandatory field is inadvertently left blank, you’ll get a refusal. This covers a wide range of information, such as addresses, plan codes, modifiers, and social security numbers.
According to estimates, blank fields are the only cause of over 60% of medical billing denials and 42% of denial write-offs.
2. Service Not Covered By Payer
This happens when your team fails to confirm that the procedures and services being provided are covered under your patient’s existing benefit plan with their insurance.
3. Duplicate Claim or Service
If claims are deemed to be duplicates, they will be identified and denied. This indicates that the claims submitted have the same:
- Beneficiary
- Services performed
- Date the services were rendered
- Healthcare provider
4. Service Already Adjudicated
When benefits for one service are combined with payments or allowances for another service or procedure that has already been resolved, this occurs.
5. Limit For Filing Has Expired
Your workers must submit claims within a certain amount of time specified by the insurance companies. Additionally, your team will be given a deadline by which to submit revised claims. Claims that are not submitted by the due date will be rejected.
You can put a plan in place to avoid healthcare denials by being aware of these typical causes.
6 Steps to Prevent Medical Billing Claim Denials
- Educate and communicate
- Verify insurance prior to service
- Know your payers
- Document accurately and appropriately
- Leverage technology
- Learn from mistakes
How Fast Billing Solutions will help to Prevent Medical Billing Claim Denials?
We have dedicated teams of professional medical billers and coders who handle all the information so precisely that there is not even a chance of mistake. We do this through different steps which are followings:
- Verify insurance prior to service
- Document accurately and appropriately
- Quantify and categorize denials
- Improve patient data quality
- Avoid incorrect assumptions and determine the true reasons for denials
- Develop a denials prevention mindset in all parts of the revenue cycle,
- Optimize claims management software
- Use automated predictive analytics to flag potential denials
- Work with payers