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Reduce Denial Rate in Your Medical Practice

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If you had to make a list of some of the major pain points associated with most medical practices, resubmitting claims would undoubtedly be right at the top.

Not only does this mean that a medical practice has to wait longer periods of time to collect money that they’re owed, but you also have to consider the costs associated to rework that claim in the first place – costs that add up in a frustrating and often surprising way.

This has always been problematic, but it is an especially difficult situation to find yourself in given everything that is currently going on in the world. During a period of time when practices need to remain more productive and more competitive than ever, you cannot afford to spend so much time working and reworking claims that do not have to be this difficult. You also certainly do not want to extend your ability to get paid for the work that you have already done any longer than you absolutely have to.

Thankfully, there are a number of straightforward steps that you can take to reduce denials in your own practice and often prevent them altogether. You just have to keep a few key things in mind.

What You Need to Know to Prevent Denials: Breaking Things Down

By far, one of the most important things to do to prevent denials from happening at all involves the acknowledgement that billing absolutely begins with the front desk.

Your front desk employees need to be checking someone’s eligibility as soon as you can – ideally two to three days before an appointment. They should verify that the provided demographic information is accurate and that they have every other relevant bit of data they need to submit the claim in the first place. Likewise, you should be educating your staff members on coding and the impact of clinical documentation on the revenue cycle. The providers themselves especially need to be educated. All of these things will make a big, big impact moving forward.

In addition to taking steps to prevent denials that occur because of coding errors, you can also make use of an external person to provide the aforementioned education to your employees. Think about it like this: the costs associated with hiring that external educator are often far lower than the loss of revenue due to a provider’s lack of knowledge. Even if you go through comprehensive training sessions twice a year with a special emphasis on the most common diagnoses and procedures used in the medical practice, you could still increase your reimbursement in the long run.

Track Denials for Better Outcomes Moving Forward

Another one of the best ways to reduce denial rates in your medical practice involves coming to a better understanding of why they may be happening in the first place. Far too often, medical practices know that denials are happening, but they are not really sure why. They are certainly not aware that, more often than not, they are falling victim to the same few mistakes that are happening over and over again. If they would just make some slight adjustments to their workflows here or there, the lion’s share of their problems would be over. But some medical practice may not have the knowledge or the resources to do that, so this frustrating cycle repeats itself indefinitely.

To get to that point, you will need to determine the root causes that you are dealing with. Oftentimes, this involves issues at the front desk (like incorrect demographic information), billing errors (like CCI edits or incorrect modifiers), coding problems (like a ICD-10-CM code for female being used on a male patient) and more.

Once you have a better understanding of why those denials are occurring, be sure to share the results with providers and office staff members so that they are aware of what is going on. Implement new processes to avoid making similar mistakes and definitely continue to monitor things in the future.

Based on that, you will definitely want to conduct internal audits on a regular basis as sometimes this can be the most efficient way to find revenue cycle gaps that would have otherwise gone undiscovered. Do not be afraid to seek independent outside help if you need to or if you happen to be busy on other projects. Symbion Coding, Inc., for example, charges a reasonable fee to provide audit services that come complete with a recommendation on how to close those revenue cycle gaps once and for all.

In the end, while the above steps may be a significant amount of effort above what you are used to, you need to consider the raw value that they will bring to the table. Not only will you spend less time re-working claims that never should have been denied in the first place, but you’ll also speed up the frequency at which you get paid and increase revenue to your practice as well. All of this frees up more time in your day to focus on those matters that really need you, thus paving the way for an even more successful medical practice in the future.

If you’d like to find out even more information about how to reduce and eliminate claim denials as much as possible in your medical practice, or if you’d just like to discuss your own needs with someone in a bit more detail, please don’t delay – contact Symbion Coding, Inc. today at (800) 672-8149 or visit our website: www.symbioncoding.com


Jean Delva
Founder & CEO of Symbion Coding, Inc.
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