What You Can Do to Cut Down on The Instances of Healthcare Claim Denial

What You Can Do to Cut Down on The Instances of Healthcare Claim Denial

Denied healthcare claim is a growing concern among medical practices because it often appears that every other claim faces refusal. Many people might think that the medical reforms that are underway could alleviate the problem, but this could be a wrong perception. The reason is that the majority of claims refusal occurs due to mistakes and negligence in medical billing and coding, which has nothing to do with the reforms. What is required to mitigate the problem is to have a claim denial management process in place but handling it can become a concern for the in-house medical billing and coding personnel. The process is considerably time-consuming and trying to do it manually can turn out to be frustrating. Instead, seeking the services for Outsourcing Insight, a company that is expert in managing accounts receivables is an efficient way of handling it.

Claim refusal - reasons

Almost fifty percent of the claims refusal happens because of insurance-related issues. The most important thing to consider when extending medical services to patients covered by insurance is to ensure that the patient procedure has proper coverage in the medical insurance policy. Another very concerning reason is that the eligibility was no more in force because it had expired.

The solution

Against the above backdrop, it becomes quite clear that before you provide medical services to patients covered by insurance, you should verify the insurance document carefully to ensure that you do not face any hurdles during claim settlement and receiving payment. You need to have a robust process for insurance verification together with a denial management process so that the difficulties are taken care before it can create problems. Ideally, you should hire the services of a professional company that can handle the entire function of accounts receivables that ultimately help to maintain a healthy bottom line.

Insurance verification checklist

Verification of the insurance documents is not tricky if you know what questions to ask and what data could create problems when processing claims. The process entails verifying the data on the insurance card with the respective insurance company or from the electronic eligibility systems. Besides checking the personal data like name, address and phone number, the validity of the policy (commencement and end dates), current coverage, whether the procedure of service requites is covered, exclusions of the policy, co-pay and deductible as well as requirement of any pre-authorization are points to be covered during verification.

Patient data recording

The job of patient data recording done by the in-house staff is as much important in processing claims because it forms the foundation of claims. Every entry recorded at the time of registering patient data is critical because a single error in coding or billing entry can make the difference between a successful claim and denial. Proper training to the personnel can ensure that they do not make any data entry or coding error.

The company that handles accounts receivable services can help in this regard in case your in-house staff turns out to be incompetent.

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