3 Tips to Avoid Medical Billing Denials
A denial code, when it comes to medical billing, is key in understanding why a claim cannot be processed by the insurer. Common reasons for denial codes in the healthcare system include: Missing Information, Duplicate Claim or Service, and Service Already Adjudicated among others.
When it comes to denial codes, understanding the most common types is only half the battle. Let’s go over the ways you can prevent receiving denials in the first place.
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First and foremost, your organization’s efficiency is only as good as your staff. So if your team doesn’t understand what to look out for when it comes to some of the most common denials…you’re still going to experience them at a high rate.
Let’s go over an example based on the denial code CO-18. Part of decreasing the rate of CO-18 denials involves utilizing modifiers 7 and 59, depending on the number of lines on the claim. Understanding that level of detail on one specific type of denial only happens through educating your team. Continued education and training will help your team stay up to date in the unpredictable environment that is medical billing.
Next, let’s talk about the use of clearinghouses. Based on how technologically driven the healthcare industry is as a whole, it’s likely that you have a clearinghouse partner. That’s how we got into business after all!
The ultimate goal of a clearinghouse is to act as a central point for your claim submission process. It should also help you manage your denied claims.
But, what separates any run of the mill clearinghouse partner from a great one is the additional claim services. One of the most valuable features that you should look for in your clearinghouse partner is claim scrubbing.
Claim scrubbing allows you to ensure that there aren’t any errors in your claims before you submit them to an insurance payer. Since clearinghouses deal with millions of claims and payer connections, they should be the expert in all submission requirements. Thus saving you time and money.
Last, let's talk about one of the worst mistakes a healthcare organization can make when it comes to claim denial prevention. If an organization has high denial rates, and does not have an eligibility process in place, they aren’t doing themselves any favors.
Eligibility is the process of checking with an insurance payer that the services rendered on a patient are within the scope of their insurance plan. This is because unfortunately insurance organizations don’t cover every procedure for all of their patients.
Taking preemptive steps to lower the likelihood of receiving high rates of claim denials can look like many different things. What I discussed today were just a few of our favorite strategies. Having been in the clearinghouse business for over a few decades, we like to think we know about the dos and don’ts of claim processing and want you to be familiar with them, too.
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