The only way to keep your practice afloat is to make sure your revenue stream stays steady. If you’re not paying close attention to your denial rate – and making headway toward improving it – you’re putting your practice at risk.
A denial rate below 5 percent should be the goal of every medical practice. If that seems wildly unattainable given your current performance, that’s not a good sign; consider contracting with a medical billing service to get your reimbursements back on track.
If you’re hovering in the 6-10 percent denial range, however, a few changes and improvements to your medical billing processes may be all you need to start getting paid more of the money you deserve from the payers in your network. Try the following denial management tactics, then measure the results they reap at your practice.
Track every claim: No claims should ever get “lost” in your practice management system. If that’s happening to you, it’s imperative to implement a more comprehensive process for tracking where claims stand throughout the entire revenue cycle.
In many cases, claims slip through the cracks because they’re not handled fast enough by the team at your practice. Make sure your coders are coding every encounter on the same day as the date-of-service (one day later, at most) then upgrade your technology to a system that scrubs, submits, and monitors claims with minimal employee effort.
Identify the why: Simply put, you can’t lower your denial rate if you lack an understanding of why your claims are being denied! Review all of your denial notices from a set period of time – say, three or six months – and log the associated reasons for denial.
The most common reasons for denials relate to registration (insurance verification, incorrect payer, cannot identify patient) or charge entry (invalid or incorrect procedure or diagnosis codes). The good thing about those kinds of denials is that they can be traced back to the party responsible. Look for patterns, then talk it out with the staff members who are repeat offenders.
Follow up in time: Only a small percentage of medical practices actually follow up on claim denials and resubmit them corrected or as appealed. If you’re not part of that subset, you’re saving payers money at your own expense!
Most denials can be corrected and resubmitted within a given time frame, which varies from payer to payer. Find out what the window is for each of your major payers, and make sure it never slips past you. Better yet, create a window of your own – five to ten days – during which it is your billing team’s top priority to follow up on each and every denial and correct or appeal when appropriate.
...and if you need help with your practice revenue...