The way you handle your claims is one of the important factors in determining the financial success of your practice. Whether all your claims get considered or rejected, it has a significant impact on your cash flow.
A Medical Group Management Association (MGMA) report says, even the best medical practices have 4% of denied claims. 65% of the denied claims never get re-submitted, and the cost of resubmitting a claim is also high.
If you do not research the reasons for denial, or correct and re-submit it within the time frame, you will not get paid.
Here is everything you need to know about successfully managing your claim denials:
Identify the Reason for Claim Denial
The first step to manage the rejection is to look for the reason why a claim has been denied. Some of the common reasons include data entry errors, failing to link diagnosis to CPT codes, registration issues, and less patient data.
When claims are returned, the insurer indicates a reason. These reasons are known as denial codes in medical billing. They come by the name of claims adjustment reason codes (CARC) and are applied to the current procedural terminology (CPT) code.
The CARC codes come in an alpha-numeric form (CARC 5) so that you can map the insurer’s code with the description of the reason. Some of them are cryptic, while others come with two-letter alpha codes. These codes have remarks and reason with them.
Insurers also tend to use the legacy and non-standard codes.
It is difficult to decipher all the CARC codes, but identifying the reason is essential to get claims paid successfully.
Manage the Claim Filing Process
Whether your claim gets denied or rejected, make sure you have a claim management process in place.
- Sort the claims by reason denied.
- Send back the denied claims to the concerned individual.
- Create a standard workflow and develop a process so that there are a reduced number of claim rejections.
Re-submit the Denied Claims Within a Week
Most insurers have a time limit for re-submitting claims. If your claims are denied more often than others, review the insurer’s policies and the communication associated with the rejection.
Some of them also have specific requirements so you should be aware of:
- Deadline and submission requirements for filing the claims.
- Requirements for making an appeal.
- Deadline for submitting the correct claims.
Double-check the data, review the codes; call the patient, if required. Non-payment of the claim submission due to delays on your end is the last thing you want.
Track your progress regularly
As you submit the claims, keep track of denied and successful claims. If the claims are denied regularly, look for the following parameters:
- Are the claims denied for the same reason?
- Do the claims get lost?
- Do they expire?
- Are the claims taking too long to complete?
If your answer is ‘yes’ to all the above questions, it’s time to review your claim filing process.
Outsource Your Denial Management Process
There are numerous reasons such as coding errors, duplicate claim submission, using incorrect patient, and more due to which claim denial occurs.
Fixing and re-submitting those takes time and also consumes staff resources.
To get claims paid and save on the valuable resources, you can outsource the process. Taking assistance from professionals will not only streamline your claim management process but will also reduce the number of denied claims. You will also get more time to focus on the other areas of your practice and generate revenue.
GreenBills is a powerful patient-friendly platform that assists you in creating informative and simpler bills for patients. Our main objective is to focus on maximizing the insurance payments by properly processing your claims.
Many practices have already achieved significant cost savings by improving their bottom line 10% to 25%. You can leverage our expertise in processing claims effectively.