Three Steps to Avoid Denials and Increase Reimbursement

Running a successful practice relies on getting reimbursed for services in a timely manner. After all, the best physician and staff can only operate while the bills are being paid. Coding and billing can be a time consuming function in any practice, but proper coding and timely submission are necessary. Often, healthcare practices find themselves inundated with claims denials that must be made up by either resubmitting the claim, passing the payment off to the patient or writing the charge off.

As we approach the deadline to implement what is in essence a new coding system in ICD-10, it is even more imperative to get a handle on why claims are denied before one problem snowballs into another. There are several steps healthcare practices can take to gain control of denials:

1. Analysis – Improper coding, non-covered beneficiaries or services and claims submitted after deadlines are often reason for denials of reimbursement. Analyzing the reasons that are commonly causing your practice’s denials can indicate areas of claims processing that can be optimized to reduce these denials.
   
2. Group Review – Once the primary reasons for denials have been defined, regular meetings with staff can be helpful. Making sure the front office staff is taking the proper verification steps with each patient is essential to avoiding denials even before the procedure has taken place. Whether the reason is improper verification of insurance or benefits not covered, the front office staff can implement a plan of action to ensure that current and new patients have all the correct information on file as well as ensure that certain procedures are covered prior to services being rendered. If improper coding is an issue, medical staff can review charts to ensure documentation is correct and adjust diagnoses where and when necessary, avoiding codes that may not be appropriate for certain services.
   
3. Verification – Claims can be technical or detailed in nature. Proper review and editing before submitting the claim is a big step towards avoiding denials. Make sure to validate that the claim is clean with the right codes, in the right format for the insurance company it is being submitted to and not mismatched in any way. Validating and editing claims before submission can be time consuming but it allows the provider more control over the end result as working denials is not only time consuming but commonly unclear and tricky. Practices will always deal with denials. Reviewing and editing claims prior to submission gets the hard work out of the way before it becomes an issue. Never add to the number of denials that have to be resubmitted tomorrow by not verifying information in the first place.

Three steps to more efficient claims processing is all it takes to progress towards the reduction of claim denials. When the practice staff works together to make sure every step in the process from denial analysis to process reviews to verification of information is in place, common errors are avoided. The result is timely claims processing, with reduced denials, increased reimbursement, a happy staff and a confident patient population.