All the medical practices wanted to improve their clean claim rate. And changes in insurance updates and demographics errors make it difficult to achieve it. As per the 2021 survey by Medical Economics, 89% of the practices said their revenue worsened because of COVID-19 and their biggest issue is because of the burden of paperwork/quality metrics. Denials are preventable if done in the right way.
While there is no set definition for revenue integrity, industry experts see it as a coordinated effort to improve your overall revenue cycle workflow and prevent revenue leakage. In this article, we provide you the strategies we can put in place to avoid denial and late payments from the insurance company.
Most of the Medical billing experts will agree that Authorization denials are difficult to get reimbursement. Sometimes the prior authorization will be obtained for the wrong codes or the benefits would be exhausted. So it is important to get prior authorization before rendering the services. Some of the insurances won’t accept retro authorizations and some might have penalty charges for providing retroactive authorization. If you wanted a seamless transaction for your process,
The main reason for not obtaining prior authorization is not having a system and checkpoint in your Order To Cash cycle. Fixing your authorization will improve your revenue stream drastically.
When the patient makes an appointment, get their insurance information and check their coverage before the visit. Even something as simple as making sure the patient’s name in your system matches what is on their insurance card can prevent a denial.
While that makes this step harder, it’s not impossible. Your office staff may need to resort to time-consuming methods of verification, like calling the insurance company. But considering the cost of reworking a denied claim, prevention does outweigh denials.
Insurance companies are regularly updating their guidelines and increasing the incentive for agents to deny the claims. So it is important to keep updating the AR team in terms of insurance denials. This is more applicable when it comes to Federal and state insurance. By working with an outsourcing company providers will be having lots of updates and information they otherwise wouldn’t have or paid lots for obtaining it.
While it is not necessary to have face-to-face meetings during the pandemic. It’s important to keep in touch with the agents using FaceTime or Zoom in addition to phone and email. Your relationship with providers and Clinical professionals. It is human to make error, and volume is immense and regular meetings help you to avoid errors because they keep track of things for you. You have to get a system that has the tools you need and learn to use it to make it work for you.”
One of the roles of the AR professional is to prevent future denials. If your process is receiving too much denials on “Non-coverage” and “Patient is not eligible”. You can consult a Medical coder and work with him on sending the appeal. And codes were made retroactive, ensuring the correct code is used for your date of service will go toward preventing Claims denials.
It may provide clarity on the billing part and can help prevent future denials for the process. An experienced medical coder can identify document-related denials in-depth, which helps us understand the loopholes.
A payable claim may be sitting in the bucket for a long time because of no proper documentation. Create a documentation education team to work with providers and billing company clients for the patients. Ensure patient advocacy is strong within your billing operation. Engage compassionate medical staff who can voice for patients and their families. Empathy is more important than ever. If we intimate the patient well and prior about the documents need for reimbursement, the patient will help us obtain the document in a much effective manner.
This is more applicable for Durable Medical Equipment(DME) products. Because most of the time it will be billed as rental and insurance will ask for the updated clinical for the patient. Involving the patient to obtain the medical records is very effective.
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