Top 10 Most Common Claim Denials

Top 10 Most Common Claim Denials

Top 10 Most Common Claim Denials

Author : Akhil Singhal Post Date : April 1, 2021 Total Views: 230

Denials can be a massive thorn in a practice’s side. Chasing claims and resolving denials can be a huge time suck for your billing staff. Today on the blog, we will share the top 10 most common denials for physician practices.

  • Verifying Eligibility & Benefits:
    • A patient who is either ineligible or has no or expired insurance coverage will result in a denied claim.
  • Missing or Incorrect Information:
    • The most common mistake is missing critical information when the claim is submitted, e.g., missing service code, fields left blank, wrong plan code, etc. Due to sheer negligence, sometimes we make silly mistakes, like the birth year 1957 can be written mistakenly as 1975.
  • Incorrect Patient Demographics:
    • Anything in the basic patient demographics can be wrong, ranging from a patient’s nickname instead of a full name on the file, wrong DOB, and incorrect insurance ID can straightforwardly lead to a denial.
  • Non-covered Services:
    • Often, we fail to check eligibility and do not call payers to determine the coverage requirements. The patient’s insurance policy determines what’s covered and what’s not.
  • Pre-certification and Prior Authorization:
    • At times, especially when diagnostic studies and complex procedures are performed, a pre-authorization (MRI, CT scans, etc.) or pre-certification as indicated must be obtained from the payer based on the patient’s plan, failing which would lead to denials and is one of the most common causes of denials.
  • Submitting to the wrong insurance company:
    • Having the wrong insurance on file and submission to the wrong payer will lead to immediate rejection.
  • Timely and Appeal Filing Limits:
    • It is not uncommon for things to fall through the cracks—especially when you’re busy. There is a set time window following service for a claim to be reported to the payer. If you miss the train, the claim is bound to be denied. Similar is the case with appeal filing window limits for previously denied claims.
  • Incorrect Place of Service:
    • Each place of service has a two-digit code, and it is mandatory to specify where the service was performed (IPD, OPD, nursing home, ER) to get paid accurately.
  • Duplicate Claim:
    • Either knowingly or unknowingly, resubmitting an already submitted/approved claim is bound to be rejected and can be considered fraudulent.
  • Poor Coding:
    • Correct coding is essential for claims, so using the wrong CPT code, unmatched ICD-10 code, or wrong or no modifier, etc., can cause rejection. Also, coding is continuously evolving, and it can be easy to use and outdated code.

Now that we’ve identified the biggest culprits, you know what to watch out for and where it pays to tame time to check your work. OmniMD has created a Clean Claim Checklist to Reduce Denials to help in your claims process. Click here to download!

If denials are a concern for your practice, OmniMD would be happy to help. Click here to schedule a call.

Optimize your operational efficiency and revenue with our state of art RCM Technology Platform. Schedule an online demonstration now.

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7 Reasons To Find The Right Medical Billing Software

7 Reasons To Find The Right Medical Billing Software

7 Reasons to Find the Right Medical Billing Software

It is no secret that the right medical billing software deliver clean claims, increase the quality and accuracy of patient information, and ensure timely reimbursement. The best medical billing software can help health care providers and medical billing specialists improve patient experience, prevent mistakes, and facilitate better revenue cycle management.

These sophisticated tools should be equipped with functionalities that trigger alerts and flag concerns that require special attention for the highest accuracy.
Here are the top reasons to get the right medical billing solution:

1.Increase Accuracy and Data Quality

Accurate documentation of patient demographic data is essential to prevent denials and get you paid faster. Manual entry often leaves room for errors. Even the slightest mistake in spelling can increase the chances of inaccurate filing and may lead to denials and audits.

By opting for the right billing partner with advanced processes and technology, you can create the highest quality data in real-time and stay on top of accounts that need special attention.

Since many claims are denied due to exhausted pre-approvals or expired authorizations, you need medical billing software which can automatically trigger alerts to about claims that need reauthorization. This can ensure uninterrupted patient care and better management.

2. Improve Operational Efficiency

With state-of-the-art infrastructure, intuitively designed healthcare accounting software brings you comfort, clarity, and more control over your data. If you have a centralized platform where you can both update patient information and manage billing and claims, you can optimize clinical and operational workflow.

An intuitive medical billing solution can improve communication and let you visualize detailed analytics for better claims management and a faster billing process. You should also be able to access data virtually anytime, anywhere

3. Get Cleaner Claims

When a claim is approved and paid on its first submission, it is usually due to clean claims. Scrubbing claims is imperative for a to ensure higher and faster reimbursement. A claim should have no errors, to eliminate additional requests for information, and stop the change of rejection.

Top medical practices maintain a clean claims rate of 90% or more. With a medical billing solution designed for multidisciplinary collaboration, you can easily collect and share patient and financial  data in less time.

By partnering with the right medical billing software company, you can ensure correct coding information, cleaner claims, and higher claims acceptance.

4. Get Paid Faster

Missed deadlines should be a thing of the past. With a smart medical billing software, you can set automatic reminders, so you can stay on top of administrative tasks.. Intelligent medical billing solutions can verify insurance eligibility before the patient is treated. It can reduce the need to call health insurance payers.

Medical practices can efficiently organize records, check eligibility, inspect codes, self-validate claims before submitting claims electronically. As you know how important it is to timely submit a claim with accuracy for faster payment, medical billing solutions ensure that you do just that.

5. Secure and Backup Your Data

Data privacy and security should be at the heart of medical billing solutions. You need medical billing software which is securely hosted on cloud-based servers, patient information and sensitive data are always encrypted across locations.

Additionally, such software provides high-quality, automatic data backup which prevents any possibility of data loss due to natural disaster or misplacement of files. The best part is you do not need technical expertise to use a billing software because they are designed to self-update.

6. Better Connect Your Practice

From collecting patient data to billing and tracking, verifying insurance benefits to seeking authorizations, healthcare accounting software should come with a robust set of tools to improve workflow and ensure proper billing.

Best practice is to integrate your billing software with an efficient EHR system. That way you get complete transparency and access to resources right at your fingertips.

With integrated software, you can access information from anywhere, easily update patient information accurately, enable electronic payments, analyze revenue data, and efficiently coordinate with other departments.

7. Improve Patient Experience

Medical billing software should work as a supportive system. It should efficiently handle the backend tasks so that you can spend more time providing care to your patients.

An integrated system can also help with scheduling follow up appointments and sending timely reminders to patients., You can manage check-in, verify insurance coverage, produce accurate bills, and send notifications when authorization is needed.

Choosing the best technology partner for medical billing is essential to give you actionable insights into clinical and operational data, simplify billing and tracking, and generate maximum ROI for your medical practice.

Interested to know how OmniMD can benefit your organization?
We’d love to tell you more.

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