Claim denials can cost your practice a load of money. This is why effective denial management is essential to ensure the financial stability of healthcare providers. It not just helps you improve your revenue but your customer satisfaction too.
So in this article, we will explore the different types of denials, reasons for denials, and our top 5 strategies to improve denial management in your practice.
First, let’s look at the 2 types of denials.
Types of Denials
There are two types of denials that you may encounter in your practice – hard and soft denials. They are
- A Hard Denial – A claim that has been rejected and cannot be resubmitted.
- A Soft Denial – A claim that has been rejected, but it can be corrected and resubmitted.
It’s essential to identify the type of denial you’re dealing with so that you can take the appropriate steps to address it.
Top 5 Reasons for Denials
There are several reasons why claims can be denied. Here are the top 5 reasons for denials that you may encounter in your practice.
- Missing Or Incorrect Information
Missing or incorrect information, such as patient or provider information, diagnosis codes, or procedure codes is one of the most common reasons for denials.
- Lack Of Pre-Authorization
Some insurance policies require pre-authorization before certain procedures can be performed and claims can be denied if the pre-authorization is not obtained or if it’s obtained incorrectly.
- Coding Errors
Coding errors, such as using the wrong procedure code or diagnosis code can also lead to denials.
- Duplicate Claims
Duplicate claims submitted for the same service can also get denied.
- Delays in Claim Submission
Claims must be submitted within a specific time frame, and if they are not, they can be denied.
5 Strategies To Improve Denial Management Process In Your Practice
Now you know what can cause a claim denial. Let’s look at our top five strategies that you can implement to improve your denial management process.
- Regularly Review Denied Claims
It’s essential to regularly review denied claims and identify the reasons for denials. This will help you identify patterns and trends and take steps to address the root cause of the denials.
- Train your staff
Ensure that your staff is trained on the latest billing and coding guidelines and regulations. This will help them avoid common errors that can lead to denials.
- Implement Technology
Consider implementing technology, such as automated billing and coding software, to streamline the billing process and reduce errors.
- Stay Up-To-Date With Healthcare Regulations
Keep up with the latest healthcare regulations and policies to ensure that your claims are submitted correctly.
- Partner With A Denial Management Specialist
Hiring an expert in denial management can provide expert guidance and support to help you manage denials more effectively.
If you are someone busy running a business and taking care of your patients, the best strategy for you is to hire a professional for the job. Lucky for you, we do exactly that and have been helping healthcare providers improve their denial management for many years. Check out our services.