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by Antonio Arias, MBA, CHBME

3 Timely Tips to Keep Denials from Decreasing Your Income


The start of a new year is a wise time to revisit some of your practice’s most important metrics around financial health. Denial rate is one of the most significant indicators of your medical billing success – but unfortunately, it’s one of the most difficult elements of your billing operation to improve.

Denials eat up an estimated 3-5 percent of providers’ overall revenue (though for some practices the number is much, much higher). Denial rates between 5 and 10 percent are considered ‘average’ across the industry, but many practices experience rates far closer to 20 percent – often, without even realizing it – even though an estimated 90 percent of denials are preventable, and many can be easily reimbursed if practices follow up appropriately.

Because the traditional way of working denials is heavily manual and inefficient – involving time-consuming calls to payers, costly claim resubmissions, and long wait times for reimbursements – many practices all but ignore the impact denials incur on the income. But by following our advice, organizations can realize significant improvements in their billing performance without adding hours of administrative responsibility to their staff members’ already full plates.

Automate Eligibility Checking

Ineligibility accounts for up to 75 percent of denials and rejections for some medical practices, yet many practices still handle eligibility checks in an unstructured, unsophisticated way – heavy on last-minute calls to payers in advance of a patient appointment (or sometimes even after services have been rendered).

Neglecting eligibility checks or managing them in an outdated way is a disservice to your patients and practice. Investing in a low-cost software tool that can check eligibility in a pre-scheduled, automated can lower a practice’s denial so much (and so easily) that it can pay for itself over the course of 2017. Alternatively, outsourcing verification and other elements of the revenue cycle to a trusted medical billing service can eliminate unnecessary eligibility issues altogether.

Enhance Your Documentation Standards

Does your documentation lay the groundwork for streamlined claim submission later on? For many practices, the answer is no: Incomplete documentation and poorly managed documentation processes can create bottlenecks in the revenue cycle process.

Your coders should always have access to clear documentation to help them select the right codes for every encounter. Does your coding team have to consult multiple IT systems to acquire the right information? Are they often contacting your physicians or nurses for more information? As the year gets underway, make sure your clinical staff members are providing comprehensive information that clearly supports the right codes without demanding extra effort from your back-office team.

Revisit Your Processes for Remits & EOBs

How long does it take you to incorporate the information from remittance advice notices (aka ‘remits’) into your medical billing process? What about explanations of benefits – do you still rely on paper EOBs? How long do they linger on your billing team members’ desks before you reconcile them with your software?

You can’t work a denial until you know it’s there, and if you consistently allow for delays, you’re undoubtedly missing opportunities for timely resubmittals and follow-ups. Embrace electronic EOBs and streamline remit management so that you’re aware of every denial as soon as it happens and can eliminate the opportunity for human error from the process overall.


Are you interested in learning more revenue cycle management tips? Visit our blog! 

...and if you need help from a medical billing company...


by Antonio Arias, MBA, CHBME

Want to see how outsourcing medical billing can help your practice? Contact a billing expert at NCG Medical today!

Contact a Billing Expert