{"id":164475,"date":"2021-12-03T02:48:14","date_gmt":"2021-12-03T07:48:14","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=164475"},"modified":"2023-03-16T02:22:24","modified_gmt":"2023-03-16T07:22:24","slug":"strategies-for-preventing-denials-in-2022","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/strategies-for-preventing-denials-in-2022\/","title":{"rendered":"Strategies for preventing Denials in 2022"},"content":{"rendered":"<section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While there is no set definition for revenue integrity, industry experts see it as a coordinated effort to improve your overall <a href=\"https:\/\/www.billingparadise.com\/revenue-cycle-management\/\">revenue cycle workflow<\/a> 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.\u00a0<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"uavc-list-icon uavc-list-icon-wrapper ult-adjust-bottom-margin   \"><ul class=\"uavc-list\"><li><div class=\"uavc-list-content\" id=\"list-icon-wrap-2608\">\n<div class=\"uavc-list-icon  \" data-animation=\"\" data-animation-delay=\"03\" style=\"margin-right:10px;\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon none \"  style=\"color:#f26737;font-size:20px;display:inline-block;\">\n\t<i class=\"Defaults-circle\"><\/i>\n<\/div><\/div><\/div>\n<\/div><span  data-ultimate-target='#list-icon-wrap-2608 .uavc-list-desc'  data-responsive-json-new='{\"font-size\":\"desktop:24px;\",\"line-height\":\"\"}'  class=\"uavc-list-desc ult-responsive\" style=\"color:#f26737;\">Get Prior Authorization<\/span><\/div><\/li><\/ul><\/div><div  class=\"empty-space  marg-lg-b20\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">Most of the <a href=\"https:\/\/www.billingparadise.com\/medical-billing\/\">Medical billing<\/a> 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\u2019t accept retro authorizations and some might have penalty charges for providing retroactive authorization. If you wanted a seamless transaction for your process,\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-177835\" src=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-1.png\" alt=\"\" width=\"700\" height=\"400\" srcset=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-1.png 700w, https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-1-300x171.png 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/>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.<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"uavc-list-icon uavc-list-icon-wrapper ult-adjust-bottom-margin   \"><ul class=\"uavc-list\"><li><div class=\"uavc-list-content\" id=\"list-icon-wrap-1061\">\n<div class=\"uavc-list-icon  \" data-animation=\"\" data-animation-delay=\"03\" style=\"margin-right:10px;\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon none \"  style=\"color:#f26737;font-size:20px;display:inline-block;\">\n\t<i class=\"Defaults-circle\"><\/i>\n<\/div><\/div><\/div>\n<\/div><span  data-ultimate-target='#list-icon-wrap-1061 .uavc-list-desc'  data-responsive-json-new='{\"font-size\":\"desktop:24px;\",\"line-height\":\"\"}'  class=\"uavc-list-desc ult-responsive\" style=\"color:#f26737;\">Verify Insurance Verification prior to submission<\/span><\/div><\/li><\/ul><\/div><div  class=\"empty-space  marg-lg-b20\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">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\u2019s name in your system matches what is on their insurance card can prevent a denial.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-177866 aligncenter\" src=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-2.png\" alt=\"\" width=\"700\" height=\"400\" srcset=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-2.png 700w, https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-2-300x171.png 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/>While that makes this step harder, it\u2019s 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 <a href=\"https:\/\/www.billingparadise.com\/denial-management-service\/\">denied claim<\/a>, prevention does outweigh denials.\u00a0<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"uavc-list-icon uavc-list-icon-wrapper ult-adjust-bottom-margin   \"><ul class=\"uavc-list\"><li><div class=\"uavc-list-content\" id=\"list-icon-wrap-1863\">\n<div class=\"uavc-list-icon  \" data-animation=\"\" data-animation-delay=\"03\" style=\"margin-right:10px;\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon none \"  style=\"color:#f26737;font-size:20px;display:inline-block;\">\n\t<i class=\"Defaults-circle\"><\/i>\n<\/div><\/div><\/div>\n<\/div><span  data-ultimate-target='#list-icon-wrap-1863 .uavc-list-desc'  data-responsive-json-new='{\"font-size\":\"desktop:24px;\",\"line-height\":\"\"}'  class=\"uavc-list-desc ult-responsive\" style=\"color:#f26737;\">Hold Regular timely meetings with billing professionals<\/span><\/div><\/li><\/ul><\/div><div  class=\"empty-space  marg-lg-b20\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">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\u2019t have or paid lots for obtaining it.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-177867 aligncenter\" src=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-3.png\" alt=\"\" width=\"700\" height=\"400\" srcset=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-3.png 700w, https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-3-300x171.png 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/>While it is not necessary to have face-to-face meetings during the pandemic. It\u2019s 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.\u201d<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"uavc-list-icon uavc-list-icon-wrapper ult-adjust-bottom-margin   \"><ul class=\"uavc-list\"><li><div class=\"uavc-list-content\" id=\"list-icon-wrap-8348\">\n<div class=\"uavc-list-icon  \" data-animation=\"\" data-animation-delay=\"03\" style=\"margin-right:10px;\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon none \"  style=\"color:#f26737;font-size:20px;display:inline-block;\">\n\t<i class=\"Defaults-circle\"><\/i>\n<\/div><\/div><\/div>\n<\/div><span  data-ultimate-target='#list-icon-wrap-8348 .uavc-list-desc'  data-responsive-json-new='{\"font-size\":\"desktop:24px;\",\"line-height\":\"\"}'  class=\"uavc-list-desc ult-responsive\" style=\"color:#f26737;\">Involve a Proficient coder\/Biller who can help write appeals<\/span><\/div><\/li><\/ul><\/div><div  class=\"empty-space  marg-lg-b20\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">One of the roles of the <a href=\"https:\/\/www.billingparadise.com\/denial-management-service\/\">AR professional<\/a> is to prevent future denials. If your process is receiving too much denials on \u201cNon-coverage\u201d and \u201cPatient is not eligible\u201d. 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-177868\" src=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-4.png\" alt=\"\" width=\"700\" height=\"400\" srcset=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-4.png 700w, https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-4-300x171.png 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div  class=\"empty-space  marg-lg-b10\"><\/div><div class=\"uavc-list-icon uavc-list-icon-wrapper ult-adjust-bottom-margin   \"><ul class=\"uavc-list\"><li><div class=\"uavc-list-content\" id=\"list-icon-wrap-5240\">\n<div class=\"uavc-list-icon  \" data-animation=\"\" data-animation-delay=\"03\" style=\"margin-right:10px;\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon none \"  style=\"color:#f26737;font-size:20px;display:inline-block;\">\n\t<i class=\"Defaults-circle\"><\/i>\n<\/div><\/div><\/div>\n<\/div><span  data-ultimate-target='#list-icon-wrap-5240 .uavc-list-desc'  data-responsive-json-new='{\"font-size\":\"desktop:24px;\",\"line-height\":\"\"}'  class=\"uavc-list-desc ult-responsive\" style=\"color:#f26737;\">Engage patients in obtaining documents<\/span><\/div><\/li><\/ul><\/div><div  class=\"empty-space  marg-lg-b20\"><\/div><div class=\"text-block \" ><div class=\"simple-text size-3\"><p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-177869 aligncenter\" src=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-5.png\" alt=\"\" width=\"700\" height=\"400\" srcset=\"https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-5.png 700w, https:\/\/www.billingparadise.com\/blog\/wp-content\/uploads\/2021\/12\/Marielle-Price-5-300x171.png 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/>\u00a0This 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.\u00a0<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\">[vc_message]<span style=\"font-weight: 400\">To avail of a free RCM audit for your process <\/span><a href=\"https:\/\/www.billingparadise.com\/lost-revenue-audit.html\"><span style=\"font-weight: 400\">click here<\/span><\/a>[\/vc_message]<\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"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 [...]","protected":false},"author":13,"featured_media":177834,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[721,841,716],"tags":[],"class_list":["post-164475","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-collections","category-medical-billing","category-most-recent"],"modified_by":"Erika Regulsky","_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/164475","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=164475"}],"version-history":[{"count":1,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/164475\/revisions"}],"predecessor-version":[{"id":442213,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/164475\/revisions\/442213"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/177834"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=164475"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=164475"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=164475"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}