Following Up On Denied Claims

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Few things will negatively affect your practice’s revenue like denied claims. You have to spend time investigating why the claim was denied or lose out on revenue. And losing revenue from denials is unacceptable.  

Having to work denials is time consuming, but necessary.

Let’s look at some strategies that can help your practice follow up on denied claims more effectively and efficiently.

  1. Ensure Tracking and Documentation Is In Place – Make the process of following up on denied claims easier and more efficient by tracking and documenting what is happening. Create a system that allows you to see which claims are denied, why it was denied, who is working on it, and where they are in terms of resolving the claim. This will allow you, and anyone else, to understand the status of any ongoing denied claims. 
  2. Have A Plan and Be Persistent – Have a uniform process that everyone on your staff can follow. While you probably have a few people who you trust with important work like this, it is important to have a process that can be easily taught to someone else should the need arise. And remember to be persistent. Some claims are tougher than others. Proper documentation and having a plan will make these tougher claims easier to resolve. 
  3. Remember Time Is Of The Essence – It is important to not let denied claims sit there with no action. As soon as a claim is denied the process to follow up on that claim should be started. The longer it takes to follow up on the claim, the greater the chance you will lose out on that revenue. 
  4. Communication Is Key – This is where documentation truly helps. The value of being able to look at a spreadsheet or document and understand what claims are outstanding, the reason, who is working on it, and what needs to be done cannot be overstated. Also consider including denied claims as part of any weekly or daily meetings you have with your staff. It is vital they understand the importance of settling these claims.  
  5. Learn From The Process – This is another area where documentation helps. There are multiple ways you can learn from what you document. First, you can see what claims are being denied. If you see a pattern, then you can try to prevent claims from being denied in the first place. Second, by documenting the process, you can go back and review what is being done to understand what works and what needs improvement. This will help you to refine the process to work even better. 
  6. Get Help If Necessary – Sometimes, you matter how hard you work, there are some problems that you cannot solve. Denied claims could be one of those occasions. If you find that to be the case, consider looking for outside help. You might find that you will save time, money, and ease stress in the long-term. 

No matter how good you and your practice are at submitting claims, denied claims are a reality that every practice must deal with. To prevent potentially losing out on revenue and to save time, develop a process that anyone in your practice can follow to research denied claims. These strategies we shared will help you do that.


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