Denials are a significant issue for healthcare providers. 80% of all claims are denied for a host of reasons. This has an adverse impact on your cash flow and dramatically reduces the confidence of your patients. You look unprofessional and more patients will choose to get their healthcare someplace else.
The best way to avoid these issues is to understand the most critical reasons for denials. Here are the top five reasons why medical billing claims are being denied.
Incorrect or Missing Information
Everyone makes mistakes, and it is easy to miss simple things when doing medical billing. Sometimes, the year is wrong or the date of birth is backward. Things get even more complicated with missing codes not identifying the procedure. The payer will deny claims for these errors and demand that you resubmit. The best approach is to double-check all information for accuracy. This is how you get the best results out of your Tampa medical billing.
Not Getting Prior Authorization
Sometimes, the insurance company requires that you get authorization in advance for doing certain things. A few of the most notable include procedures such as CT scans and MRIs. If you are unsure, it is always best to call the insurance company and confirm that the procedures are covered. This reduces the chances of denials, and it ensures you get paid the full amount.
The Claim was Filed Late
You are busy and there are times when your staff falls behind. The majority of insurance companies have a window when you must submit the claim. If you miss this window, the insurance company will deny the claim, and you lose revenues.
The Insurance Information is Out of Date
You want to make sure that all of the insurance information is current. Some of the most notable include getting the wrong policy numbers or sending the claim to the incorrect insurance company. You want to always ask the patient if they switched jobs or changed insurance carriers. Be sure to get the updated insurance card, make a copy of it, and put it on file.
Exclusions
Exclusions are another issue where certain services are not covered by the insurance company. We recommend contacting the insurance company before starting any procedures. This clarifies the benefits, and it gets any questions answered. You reduce the chances of getting denials by doing some communication in advance.
Stop Denials before it Happens
These are the top five reasons why medical billing claims are denied. The best approach is to have procedures in place that improve your medical billing practices. Tampa medical billing is challenging, and you want to get everything right to avoid any issues in the future. You want to always have safeguards to ensure the accuracy of all information. This is how you decrease denials by knowing and addressing the different billing challenges.
Another option is to consider outsourcing your medical billing to a third-party provider. They are current on the latest changes and have procedures in place to prevent denials. You can free up your time and money to focus on practicing medicine and servicing your patients.
