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Effective Strategies to Bring Down Medical Claims Denial Rate

Medical practices across the globe are facing a common problem – claims denial. Transition to ICD-10 and constant changes in regulations and standards are causing increased claims denials that prove to be a hindrance to several health care facilities.

Need for Monitoring and Managing Denials

Claims denial proves to be a dampener for the health care industry. Health care facilities the world over have been searching for making their regular processes precise and less time-consuming. While providing the most optimal health care to patients is seen to be the primary goal, there’s no denying the fact that maintaining the financial stability of the facility is of paramount importance. One of the most influential factors in this aspect is achieving proper reimbursement for services provided. Claims denial plays a major role in the financial well-being of medical practices.

With innovative technologies entering the medical field, and sophisticated algorithms enabling identification of claims denial, practices are now in a position to eliminate time and resource-related issues. With numerous changes cropping up in the regulations and the payment model, it is essential to develop effective strategies to handle insurance claims and manage denials. It is imperative that practices put up the necessary efforts and invest suffiecient time to manage claims denial in earnest.

Steps that Help Lower Denial Rate and Improve Revenue Generation

Accomplishing optimal revenue generation is one of the driving factors behind every organization, regardless of the type of industry. The following steps will help medical practices to achieve this:

  • Being aware of current denial rate: Denial rate and related factors such as reasons, payer, and location need to be calculated and understood
  • Understanding the reasons: Denials are caused by different reasons in different practices – the various reasons can be mapped into codes, the analysis of which would help identify the root cause of the problem
  • Denial team creation: Different professionals such as billers and coders, physicians, and others may be teamed up for collecting and reviewing relevant data – this will help create a systematic work flow for facing denials
  • Educating the staff: Training and educating the staff leads to achieving accuracy in documentation and data entry, proper filling of forms, and sticking to required rules and procedures
  • Engaging revenue cycle administrator or certified medical coder: Experts, when  employed for claims submission and denials handling, will help in ensuring error-free processes

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