For a medical billing company, denial is when an insurance company refuses to accept a request made by an individual to pay the healthcare services they require by a healthcare service provider/professional.
Healthcare providers understand that the denials are frustrating. It delays the financial process and obstructs cash flow hurting the bottom line. Requesting the insurance companies and processing them, again and again, will interrupt the existing work and of course waste a lot of time. This is why it is important for a medical billing company that the billing information is correctly made and should reflect accurate numbers.
Read further to know the common reasons for medical billing denials and ways how a medical billing service provider can prevent them.
Common Reasons for claim denials
Following are some of the common reasons for which a medical billing company can face denials:
- Lack of payment credentials
- Invalid medical code
- Incorrect database entries
- Terminated or unverified health insurance coverage
- Patient identification issues
If these deficiencies occur continuously from your end, then it can provide a lingering negative effect on a medical service provider’s practice. This isn’t something that cannot be resolved to reduce your chances of denial. To secure your revenue stably, you need to hire an experienced medical billing company that will apply techniques and reduce chances of denials for your medical billing requirements.
How does a medical billing company help reduce denials
Following are some operative ways that can be opted to prevent denials.
1. Patient data quality improvement
Providing quality healthcare data is the main agenda of the healthcare professional. It has been a necessary requirement in order to maintain reliability, accuracy, and stability of data. Because of this along with many other reasons, the healthcare data analytic application has a lot to offer positively and provide life-saving outcomes. Here’s how to evaluate if you are providing quality data:
- Conducting internal audits and training to auditors
- Maximizing protection by installing data fudging preventing apps
- Computer system verification
- Utilization of error-detection software
- Ensuring physical security
- Maintaining recovery and backup
- Setting up timely audits
However, a stable medical service company can also help you in getting your patient’s data persistently and accurately. As they remain aware of the latest policy and upgrades in the medical industry, they can better handle your documentation and reduce the chances of denials.
2. Monitoring billing denials
A good medical billing company always works to see the reasons behind your healthcare billing denials. Additionally, they will keep the track of refusal of the claim percentages and review the main issue. The reason for denial can relate to financial conflicts which need to be resolved in the given time frame.
3. Error-free coding
In medical practice, denial claims are increasing with every passing day. This can be due to:
- Coding errors
- Intricacies in the patient’s medical records
- Introduction of ICD – 10 diagnostics codes
- Current procedural terminology coding guidelines
Indeed with the assistance of a professional coder, the chances of coding errors will be significantly reduced. Before the submission of the claiming forms, a professional coder will look into the loopholes and make them error-free so the denial chances can be reduced. A medical billing company should adhere to these strategies to avoid denials due to coding errors:
- Make sure to avoid duplicate billing
- Ensure using latest technologies and medical coding regulations
- Align patients’ data with accurate information
- Double-check coverage and insurance benefits
- Avoid incomplete and incorrect billing information to increase reimbursements
4. EHR Electronic Health Record – Backup System
A professional billing service provider prioritizes managing the backup system to gather and secure data of millions and trillion of patients. The medical billing companies do not only keep data but secure them at any cost from theft and breaches. Moreover, by using the latest high-tech security for data protection, these medical billing companies make sure that documents, records, reports, and progress are protected according to the Health Insurance Portability and Accountability Act – HIPAA.
5. Constant monitoring of alteration in medical guidelines
Medical billing companies observe latest updates, changes in policies, and criteria alteration in new medical billing to make sure that they are applying the same billing techniques that can prevent denials.
When you foresee more accepted claims, it is essential to stick to the latest insurance updates and requirements for an approved claim. Besides, keeping a medical billing company at your back will allow you to do so without putting yourself in such hassle.
An expert in medical billing service prioritizes, identifies, and analyzes the significance of reducing denials against your practice. A medical billing company can help determine resources, document everything, and track progress to avoid denials for you.