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Healthcare departments have a significant influence on your practice. They can also cause significant damage to the income revenue stream when facing claims denials. When your practice faces constant rejections, it casts a poor influence on the cash flow and affects the  practice as a whole. According to other American academies, physicians’ practices suffer close to 5-10 percent revenue loss due to constant claim denials. According to research by the Medical Group Management Association, there has been a 69% increase in the rejection of denials since 2021. This status is a red light and demands prompt solutions. Further, you can outsource your billing tasks to professional medical billing practices.

Recognizing the Root Cause

  • Verify patient information at the front desk: Physicians with private practices or the healthcare organizations need more time to provide patient details. This leads them to financial losses. To avoid this, practices must kick-start their verification process at their front desks.
  • Train your front-desk staff– Make sure there is no missing information. Missing information can be incorrect plan codes, technical errors, or misplaced modifiers.  
  • The patient does not have coverage for the insurance plan– front desk staff can quickly get hold of fifty patient plans or call the insurance company before submitting the claims.
  • If the provider is not in the networkthe payer will not issue the payment if the physician is not from the insurance network. 
  • Duplicate claims– double claims submissions for a single medical procedure. 
  • Bundling – Instead of paying fees for each service individually, the payer binds them together and makes the payment on time.
  • Services already included for the payment of other medical procedures – It occurs when the benefit for a service is included in a payment or allowance for another service or procedure that has already been adjusted.
  • When Exceeding time limit– this situation may occur when claims are submitted after the due date, and one has to resubmit the claims repeatedly.

One can also prevent denial by understanding denials’ root causes. Detailed codes fall into four families, these are:

  1. Adjustments code
  2. Payer-initiated Reductions (PI) 
  3. Contractual Obligations(CO)
  4. Patient Responsibility (PR)

For instance, CO-4 is utilized when there is inconsistency with procedural code and the modifiers used or required modifiers are missing for adjudications. You can prevent this by using the relevant modifiers for the procedure. PI-204 comes in when equipment, services, or any other drug is not included in the patient’s current benefit plan.

Best strategies to combat denials in medical billing practices

The following practices can bring the best solutions to staying organized and overcoming the denials: 

  • Analyze the stats: Knowing the root causes of the disk and the currency rate can be the first and foremost reason for the massive number of denials; when you know the stats, you can improve the process and eliminate problems.
  • Keep the process in apple-pie order: losing the bundle of claims will not bring revenue to the organization. While climbing the details leads you towards some severe admirative issues; however, implementing serious denial management procedures helps you to submit clean claims. 
  • Follow the trends:  medical billing audit is the first and foremost accurate tool to pinpoint the mistakes in the denials. 
  • Resubmit the claims quickly: Once the cases are denied for any reason, do not get demotivated; identify the causes of the denial, and re-submit the denials as soon as possible. 
  • Build a medical billing team: You need to hire professionals in your medical billing company. There must be professionals who can manage and help identify the root causes of the claim denials. A medical practice necessitates professionals for each category, like creating quality assurance, medical billing, expert coders, etc., for submitting and verifying claims. 
  • Collaborate with the insurance company: payers can maximize revenue and reduce claim denials by collaborating with the insurance companies,
  • Monitor progress: Monitoring will help you analyze the weak areas and do the dots of everything. You can also automate the denials management process, saving your hustle of submitting the claims repeatedly. 
  • Learn from your mistakes: Carelessness in data management can cause claim rejection, so you must manage the insurance information according to the ID listed in the electronic health record (EHRs) and the insurance company. Tracking and paying attention to the causes of rejections make it easy to comprehend the problem quickly. 

Try to meet the deadline in the best possible ways. Try to meet the deadline set by the company.


Outsource billing and coding to a cost-effective medical billing company

Due to constantly changing regulations and payer rules, many hospitals and practices need advanced technology and professional staff to manage denials effectively. Outsourcing revenue cycle management to experts like prgmd, who have expert denials management teams, can be a profitable, cost-effective solution. By establishing medical billing benchmarks, reducing backlogs, identifying root causes of denials, and augmenting your revenue cycle teams, medical billing services like Physicians Revenue Group can help you achieve these goals.