Reducing Denied Claims


There are very few things that will upset a practice owner or manager more than an increase in denied insurance claims. From having to rework the claim to potential lost revenue, there is nothing good about denied claims. 

As we have stated in many blog posts before, if you are unable to effectively and efficiently collect on the services you provide, then your practice will struggle in a variety of ways. 

If you are seeing an increase in denied claims or you would like to be proactive in preventing denied claims from becoming and issue, take a look at six ways you can reduce denied claims. 

  1. Proper Training – The first step to reducing denied claims is to make sure that the people submitting the claims are properly trained. This might seem intuitive, but that is not always the case. Many denied claims are caused because minor mistakes were made. And those mistakes could have been avoided with proper training. 
  2. Prior Authorizations – Obtaining a prior authorization is critical when it is required for a particular service by insurance. Make sure your claims are not denied for failing to obtain a prior authorization.
  3. Improve Your Process – As your practice grows and evolves, you may have to look at how you submit claims. If you are noticing an uptick in denied claims you may want to look at how quickly your team is submitting claims or determine if there is some other potential cause. Once you identify the potential reason for increased denials, then you can implement proper corrective actions. 
  4. Stay Current With Coding and Billing Regulations – Billing and coding is forever changing. This means that you must stay current with any changes to policies and regulations. 
  5. Document and Learn – Make sure that you document the reasons for denied claims. This will make it easier for you to spot any trends, which in turn will help you implement corrective actions. Also, do not forget to document the best billing and coding practices for your particular practice. It is important to highlight and remember what you do well. 
  6. Maintain Effective Communication – We mention communication a lot in these types of lists and for good reason. Almost everything we listed to this point involves some sort of communication. While effective communication is necessary for all aspects of your practice, it might be most important when it comes to submitting claims because of the potential impact on incoming revenue.

BONUS: Outsource Your Billing and Coding – We have mentioned this before, but you might be surprised at how much time and money you can save by outsourcing your billing and coding. And a company, like Mednet, whose sole purpose is to make sure you get paid what you are owed will greatly reduce the amount of denied claims you see. 

Denied claims will halt the growth of your practice like nothing else. If you want to prevent this from happening, then you must take the necessary steps to reduce the number of claims that get denied. 


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