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Tips for Cutting Rejection and Claim Denial Rate 2020-06-23T20:39:09+00:00

Tips for Cutting Rejection and Claim Denial Rate

cutting claim denialsThere really are few things more irritating in life than dealing with a false claim denial from an insurance company. For health care organizations, more specifically billing specialists, however, this is a normal and integral component of their work. According to the American Academy for Family Physicians (AAFP) the average claim denial rate in the health care industry is between five and ten percent. The most important notion to keep in mind when dealing with claim denials and rejections is to have an understanding for the reason behind them. The Advisory Board conducted a study that revealed that close to ninety percent of claim denials are preventable.

Common Mistakes

The goal to keep claim denials closer to the five percent mark can be challenging for some health care organizations. There are several common mistakes that keep health care practices claim rates higher than necessary. Relying on manual processes for managing and filing data can lead to unnecessary mistakes and result in otherwise avoidable denials. It is not uncommon for health care organizations to utilize gratuitous resources when carrying out claim appeals. Spreading an organization’s resources unnecessarily thin can draw away attention from and negatively impact other pertinent areas of the practice’s function. Some health care organizations do not properly track their denial statistics. This information is essential to understanding and implementing needed changes to reduce claim denials. 

Tips To Reduce Claim Rate Denial

Although some of the advice to reduce the number of claim denials is not necessarily as clear-cut or universally relevant as one may think, there are several general tips that can lower the claim denial rate when properly employed by a health care practice. Below are some examples of tips a health care practice can try to stay on top of claims, cut unnecessary rejections, and lower their claim denial rates:

  • Make sure to have an appropriate and efficient management strategy in place to handle claim denials. 
  • Medical billing software is becoming increasingly relied upon and has shown to lower the frequency of human error, minimizing the occurrence for potential claim denials. 
  • Keep track of the company’s claim denial statistics.
  • Organization is key.
  • File claims on time.

Coding accurately can greatly reduce the number of claim denials. Ensuring that a claim is filed and coded with the highest level of specificity is crucial. Rules and regulations surrounding medical billing are constantly changing. It is essential to stay on top of the current rules and regulations, and follow them accordingly to avoid unnecessary claim rejections. Following up on claim status is a fundamental, albeit time-consuming, step a medical billing professional must take in order to obtain payment for services rendered. Although this can be an effective method, it may behoove a health care practice to take a more proactive approach. Employing a more proactive approach with regard to monitoring claim submissions can increase the number of claims that are paid the first time around, avoiding claim rejections and the need for claim resubmissions. While claim rejections and denials are to be expected in the health care field, if managed properly, they can be significantly reduced. 

Further Information

As insurance regulations change, it is imperative that companies understand how each change can affect their practice, in all aspects. Insurance companies are notorious for offering excuses and utilizing loopholes to avoid paying providers what they owe. Accreditations such as CARF and JCAHO are now a common requirement for insurance companies to render payment. These certifications alert the public that a company has been adequately inspected and is considered reputable, meeting the accreditations high standards. The accreditation process can be arduous, requiring a significant amount of time and energy. Our staff offers diverse skills that enable Oracle Billing and Services, Inc. to assist in areas ranging from CARF-Accreditation, Verification of Insurance benefits, Insurance Collection Calls, Drug/Alcohol state licensing, JCAHO-Certification and more. Oracle Billing and Services has extensive experience in assisting companies in the health industry, in understanding the ever-changing regulations as well as providing expert consultation for all areas of operations. Reach out today and schedule an appointment with Oracle Billing and Services via phone at 626-872-7344. We look forward to connecting and helping to bring your company to the next level. 


Further Reading

Resolving Past Due Claims