How to Prevent Claims from Being Denied

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Last month, we shared the five ways Mednet makes you more money. Although the list was in no particular order, the first item was submitting accurate claims. As this infographic illustrates, the average cost to file a claim is $6.50. The infographic also details that the cost to resubmit a claim ranges anywhere from $25-$118. The total cost to submit, correct, and resubmit a claim can range anywhere from $31.50 to $124.50 — costing your practice thousands of dollars per year.

Here are some other troubling numbers from a report on beckershospitalreview.com:

  • According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20% of all claims submitted
  • As many as 65% of claims denials are never worked, resulting in an estimated 3 percent loss of net revenue
  • Roughly 67% of all denials are appealable

We are not sure about you, but losing 3% net revenue does NOT sound like the best way to run a business.

Mednet gets paid on over 98% of all the claims we submit, so we firmly believe we are experts in preventing claim denials. Here are some of our top tips to help you prevent your claims from being denied:

Do Your Homework: Part I

The only real constant in the medical industry is the change. Your staff must be on top of any and all changes in rules and regulations. By fostering an environment of constant learning and improvement, everyone on your team will understand the importance of staying up-to-date, eliminating denials due to failure to keep current.

Do Your Homework: Part II

Look internally and investigate the cause of past denials. Understand where mistakes may have occurred and how you can avoid them in the future. If necessary, implement corrective actions to curb future denials.

Work As A Team

Denied claims affect the entire practice. Everyone on your staff should understand this. Even if they do not work directly with billing, each staff member should do their part to ensure the billing process is a smooth one. Help your team communicate what is needed, and, when a mistake happens, do not rush to place blame. Take time to search out the cause and help them understand how to prevent it from happening in the future.

Make Sure Pre-Authorizations Are Done Correctly

Pre-authorizations can help lower the number of claims denied, but only if they are for the scheduled procedure. Carefully document what was authorized and do checks before the procedure. If anything changes, document what was changed and double-check everything before submitting the claim.

Work Smarter

This is a broad category that encompasses the above points, but also includes:

  • Incorporate automation: Many software providers have tools that will help automatically update codes and procedures. Tools like this, as well as other project management tools, streamline the billing and claims process.
  • Review your work: This seems like a simple step, but for one reason or another, it is often overlooked. Working as a team can help with this step because it is easier to spot someone else’s error than to catch your own.
  • Meet deadlines: Meeting deadlines is essential. There is no excuse for having a claim denied because you missed a deadline. Again, working as a team can prevent a missed deadline.

In the end, you can help prevent claim denials by setting up a process for your team to follow. Set up a system that you can repeat for each claim that also allows for periodic review so you can determine where you need improvement.

It may seem daunting, but can you truly afford not to follow a process? It can cost you as much as 3% of your net revenue.

If it’s still too overwhelming, remember that Mednet is here to help with your medical billing needs. It might be a worry we can take off of your plate so you can focus on more important things, like your patients.


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