Denials are common things in today’s health care scenario. With hectic activities and the continuous need for providing flaw less care to patients, medical professionals and practices may not be fully prepared to efficiently respond to the different types of denials that they face each day. Major issues that prevent responding in a timely manner to denials are staff shortage and lack of expertise or knowledge!
Different Types of Claims Denial
A few of the denial types have been listed below:
- Medically unlikely edit
- Medically necessary
- Partial / No authorization
- Coding & Documentation
- Different procedure billed
- No valid CPT codes
Common Reasons Causing Claims Denial
- Incorrect patient data
- Ineligibility of patient: health insurance cover insufficient or terminated
- Benefits might have exhausted
- Outdated or obsolete diagnostic codes
- Authorization or pre-certification missing
- Modifier is missing or inappropriate
- Billed as outpatient but Inpatient procedure has been performed
- Medical records request not received
- Provider being out of network
How to Manage Denials
It is not surprising that several providers from private practices to multi-specialty facilities are either short of required staff or are lacking the necessary expertise for handling the constant changes that keep occurring in the health care environment. Many are seen to be hectic with their staff already overworked and they do not find time for working on claims denial.
It is good business sense to outsource denials; it allows current staff to focus on future denial prevention as well as prompt collection of dues from patients at the time of providing services.
Effective Ways to Prevent Denials
A major portion of the claims denial may be prevented with appropriate training being imparted to physicians and their staff. By training, staff team is rendered adaptable to the continuous changes that keep cropping in.
Another factor that helps avoid denials is technology advancement. Electronic billing enables accurate billing and prevents claims being released to the clearing house till all corrections have been applied.
Why Rapid Care?
Outsourcing denials to experienced service providers such as Rapid Care Transcription Pvt Ltd helps reducing the reimbursement time frame while ensuring that denied claims may be re-submitted within the required time.
We have been providing medical billing and coding services to medical practices of all sizes since a decade. For further details, please visit our website www.rapidcare.net