Your claim was denied.
We’ve all been there. Whether the notice comes from a private insurer, Medicaid, or Medicare, there are few things more headache-inducing in our profession than a denied claim. A denied claim means it’s back to the drawing board to refile the claim again. It also means you have to wait even longer to collect on the revenue you are owed.
Your time and your bottom line must be protected at all costs. You can reduce your risk of denied claims by following these eight tips.
- Adopt automated solutions wherever possible. The more you can remove human error from the equation, the fewer denied claims your practice will deal with. Investing in an EHR solution provides your business with specialized software that self-codes correctly at the highest reimbursable billing level. This means more of your claims will go through properly the first time and that you’ll earn more money on each claim.
- Check patient information and check it twice. In many cases, the most common cause of a denied claim is also the simplest to fix: inaccurate or missing information. Name, date of birth, Social Security number, and address are all common places for a misspelling or — particularly in the case of addresses — for information to be out of date. Consider using a patient portal so that patients can easily update their own information. Remember, there are more than 350 elements of data in any claim, and an error in even one of them can be grounds for denial. Taking the time to verify the information — as well as the fact that the work is meeting the applicable policy network requirements — can save you time and reduce instances of a denied claim. A phone call the day before a patient visit can provide your team with all the information they need on a patient’s insurance policy, and regular quarterly checkups to payers are advised to make sure there are no fundamental changes to their policies.
- Learn from past rejections. When a rejection occurs there is always a reason, and in some cases it’s because the proper data has not been established. EHR software solutions like ICANotes offer an Insurance Payer Short List. Use this list to establish not only applicable insurance types, but payer IDs and ANSI options for all patients that share a given insurance. Streamlining this process will help you reduce your rejection instances in the future.
- Meet the deadline. Deadlines are a part of life, and they affect claims filing as well. Be sure that your claims are being filed before the filing deadlines outlined by insurance providers. This ensures that your claims will be fitted with the proper CPT and HCPCS codes if necessary.
- Get acquainted with your clearinghouse. Your clearinghouse is an integral partner in the filing process. From enrollment assistance with insurance payers to reviewing outgoing claims and remittances online and getting detailed explanations when rejections occur, you work side by side with your clearinghouse constantly. Don’t take this relationship for granted. Take the time to learn more about your points of contact and build a strong relationship with them. Nurturing this partnership will improve the processes for both of you.
- Know your claim format. All practices using EHRs send their claims through a standardized format. If a claim is denied, understanding that format can make it easier to rectify the problem. For example, most practices submit their claims in ANSI 837, and knowing this allows you to demand applicable ANSI loop and segment references in the case of a denial. This is much more efficient than sifting through obsolete HCFA 1500 box numbers.
- Keep an appeal in your back pocket. If you have a Medicare or Medicaid claim denied, being able to prove you’re up to standards illustrated by the National Correct Coding Initiative (NCCI) can help you in your appeal. You won’t always win, but it’s better to have NCCI on your side and at the ready than to go without.
- Never stop learning. Healthcare is a market of constant innovation and change, and the claims process is no different. To keep up, schedule a refresher training every six months to make sure you’re on top of the latest changes. Your EHR will update regularly and this refresher can help you learn more about new features that make the billing process easier and, possibly, reduce your risk of claims denial. What could be better than that?