|Managing Denied Claims|
|Written by Amy Lillard|
Claim denial is the problem no one wants to address. It’s an issue that seems cumbersome, annoying, perhaps a bit wasteful. But denied claims are a much bigger problem than suspected.
According to the nation’s largest hospital research organization, the Advisory Board Company, the cost of denials to healthcare organizations range from one to three percent of total revenue. Impressive, right? There’s more. Approximately ninety percent of denials are preventable, and 67 percent of denials are recoverable. Healthcare organizations are missing out on significant revenue due to denials that can usually be prevented.This article will describe the problems that practices and organizations face with denied claims, and some approaches to better managing and recovering outstanding revenue.
For years, practices and hospitals have cut costs as much as possible to increase revenue. But there’s an even bigger and untapped revenue source in denied claims.
Denied claims are underreported and unrecognized, due to the same issues that cause them:
For all these reasons, denied claims are often written off as bad debt, never to be recovered.
Resolving denied claims
To properly resolve current and future denied claims, you, or medical office manager, should take a close look at your current process. Analyze the reasons most frequently given by payers for delays and denials. Also, look at the following percentages:
Revamping your denied claim situation must involve several key considerations:
Once you have reviewed your current situation of claims and denials,
and considered the many opportunities to revise your system, there are
also specific methods to improve certain claims.
Resolution: Be sure to collect insurance information for every patient upfront, before the appoitnment. Copy insurance cards, and at subsequent visits, ask patient if the information is still current.
Resolution: Confirm all insurance prior to visits, and make note of at the visit.
Resolution: Ask patients if they have secondary insurance. When claims are submitted, send a copy of the Explanation of Benefits from the primary payer
Resolution: Collect Medicare information upfront, and at each visit. Also, remember that if Medicare is the primary payer, they usually send claims to the secondary payer. If you submit as well, it will be denied for duplication.
Resolution: Don’t automatically rebill outstanding claims. Contact the payer for more information first.
Resolution: Double-check each prior to sending, especially coding
Sources for this article include:
Moore, Pamela. Managing Medical Necessity: How to Turn Around Denials and Get Paid. Physicians Practice Digest.
Medical billing clearinghouses - information on outsourcing billing function of a physician's practice.
About the Author
Amy Lillard was a regulatory and marketing professional at the Feinberg School of Medicine at Northwestern University for 4 years prior to writing on healthcare topics.
The author discloses no financial conflicts of interest with the content of this article.
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