Recently, people all around the world have dealt with COVID-19, and we are still fighting its side effects in different domains. Moreover, we can see a prominent impact on financial conditions, as the rate of unemployment has abruptly increased. In this scenario, we take an overview of the US healthcare industry, and medical billing services are no exception. We observe that there has also been a substantial increase in the number of denials for claims submitted by medical billing and coding companies. We can list multiple factors that have proven to be a hurdle for successful reimbursement and denial management.

Therefore, we should be more concerned in addressing these insurance denials. The reason might not be known, but what we can assure is an accurate billing process that improves medical billing and ultimately reduces the financial strains in the healthcare system. Only then can a provider practice the promised care on their patients.

Listed below are some of the crucial measures professional medical billing services can do to effectively tackle insurance denial. Let’s dig in!

Verify Patient Details Beforehand 

Insurance denials frequently occur due to errors in the prior authorization process. Often, medical practices either have staff shortages or non-serious members on their teams. In any case, the consequence is the same when the required information is not even processed, and if processed, the team does it carelessly.

It is of the utmost importance to attend to a medical patient to get their necessary information immediately. In most healthcare facilities, this job is most often performed by a receptionist. 

The receptionist can check and verify the patient’s insurance ID and details, like, whether their insurance company covers the services that the patient needs for treatment, the general terms of their insurance, and some demographic information, such as:

• Patient name 
• Family history
• Address
• Medical history
• Appointment

If the relevant medical billing services staff make clear moves and gather relevant and correct patient data either on their first appointment or check-in, we can avoid insurance denial to a greater extent.

Be Sure To Remind Patients of Their Duties 

A provider must deliver medical assistance and care to their patients. They are always committed to providing their sincere efforts to help their patients deal with their illnesses.

However, there are some responsibilities on the patients’ side too. And, they must be mindful of them.

One such responsibility of patients is to pay for the services they receive during their Medicare Part B stay and subsequent visits for check-ups, meaning copayments and deductibles, as this might be another cause of insurance denials.

We can arrange a reception area in the hospital to facilitate patients, as well as explain to them what is due on their end. Also, we can take their sign-on acknowledgment forms, so that they get informed of their duties, or we can simply generate emails from time to time. Generally, medical billing services utilize this option.

Hire a Competent Staff 

Medical billing is an important job that decides the growth and financial status of any practice. That’s why hiring expert and competent medical billers and coders is a requirement of the job.

Only expert medical billing services can know how crucial it is to pay attention to the training and education of the required staff. They safely process accurate data about patient information, given treatments, and their coding, to avoid denials.

Update Your Medical Billing Software

Instead of dealing with complex medical information manually and bearing insurance denials due to several manual errors, why not use updated medical billing software like an EHR?

Alongside this, we can automate several repetitive tasks of medical billing services via RPA. All such mediums are safer options when compared to traditional billing software unless you are using an advanced version of them.

Get the Filling Done on Time 

A medical billing officer must be quick in their actions. They must file the details for claim submission for each Medicare patient and send it to the clearing house as soon as possible to get on-time reimbursements. Additionally, checking in on the submissions can help them minimize the chance of any insurance denial.

Regular Medical Billing Audits

Sometimes, a practice thinks that they are working great and have the best team for handling a variety of steps in medical billing services, but still, they get claim denials.

This puts a question mark on them. They try to figure out their mistakes but can’t, as everything seems too sophisticated and complex for them to examine as a whole.

Therefore, performing a medical billing audit with regularity is a good option instead of dealing with denial management repeatedly. Even if your practice is working fine, still it is highly recommended to perform an audit for better overall performance.

In Conclusion…

Claim submission is already a tough job for the medical billing services team. So, if they get an insurance denial, this is ultimately a waste of the staff’s work and time.

Therefore, we must avoid claim denials by wiping out all the factors contributing to any claim rejection. Still, if you receive any denial, then the medical billing and coding team must give an immediate response with effective denial management to avoid financial constraints for their practice.