How to lower your claim denial rate!

In 2017, very few things are more frustrating to an independent Medical Practice than having a claim denied by a payer. Denied claims result in delayed payments when you least expect it, or worst-case scenario, absolutely no payment at all. Most practices don’t even know why claims are getting denied, nor do they understand what their claim denial rate actually is, let alone why it is as high as it is. One thing we know at Medical Revenue Solutions, is that practitioners have tools to make a positive impact on that rate in which their claims are denied. While it’s next to impossible to have a perfect denial rate, many claim denial reasons are avoidable. Here’s is how to tackle the pesky claim denial rate!

Your current rate of denial.

Before we jump ahead, you at least need to understand what your current rate of denial actually is. As a Medical Practice, you should know what percentage of claims get denied by payers so you can establish a foundation of where you are now, evaluate if what you’re doing is working or not working and implement actionable changes to make improvements to your denial rate – which can be measured against the baseline where you started.

To start, knowing the denial rate itself isn’t enough. You do need to track specific pieces of information about each denied claim, and your denial rate should be calculated over a specific period of time; monthly or quarterly. Tracking your denial rate over a specific time period will allow you to grasp if your implemented changes have had an impact. Pieces of information that should be tracked include;

  • Payer
  • Reason for denial
  • Patient demographics
  • Coding

Why are claims being denied?

By understanding your current rate of denial using the information above, you will have better understanding of why your claims are being denied, common problems among your denied claims and be able to develop an action plan to fix the underlying problem. It could be as simple as missing the deadline for filing a claim, which is incredibly common. Another common problem includes incorrect information, such as an address or modifier. There are plenty of others reasons to, including “lack of medical necessity” or not having authorization to treat the patient as an out of network provider. Whatever the reason may be, its best to start contemplating the pros and cons of outsourcing to Medical Revenue Solutions.

How to lower your claim denial rate by Medical Revenue Solutions

It’s time to outsource.

Today, one of the most common ways medical practices have lowered their claim denial rate is to hire a third-party company like us, Medical Revenue Solutions. As a revenue cycle management company ourselves, we’re able to help you identify flaws in your claims process, take over the claims process entirely and execute actionable changes that will avoid errors, increase acceptance rates and build stronger cash flow. We understand how time consuming and overwhelming running an independent Medical Practice can be. Do yourself a favor and schedule some time that best fits your schedule to chat with us – without any sales pressure, commitments, fee’s or obligations. We understand making the decision to outsource is tough, but we’re here to help you figure out if it’s the right decision for your business.