- December 12, 2024
- Posted by: Josh Knoll
- Category: Fertility Clinic Billing
Are rejected and denied claims draining your practice’s revenue?
Frequent changes in CPT codes and implementation of ICD-10 accurately add layers of complexities in fertility billing services.
Different studies have identified that more than 8% of claims are denied and fertility clinics lose a substantial revenue due to this.
In this situation, you either throw up your hands in frustration and let revenue slip away or you take proactive measures to slay the denial monster before it spreads its tentacles too far.
This article has outlined the proven strategies and tools to manage and prevent claim denials. This blog shows you how to achieve positive outcomes by leveraging technology and implementing the correct strategy in your fertility clinic billing processes.
Behind the Curve
Denial management is nothing new in the healthcare industry and fertility practices are constantly dealing with the issues. There are numerous factors that are contributing to increasing denials rates, such as- erroneous billing and coding, lack of insurance eligibility verification and prior authorization, lack of adherence to compliance and so on.
On top of these intricacies, it has been found that most of the fertility practices are not using any denial management tools. Furthermore, more than 30% are using manual processes and some of them use homegrown tools.
This in short, is increasing the inefficiencies within your fertility clinic billing and elevating the chances of revenue loss which is concerning for your practice’s financial and functional health in the long run.
4 Denial Management Metrics in Fertility Billing You Should Track
Percentage of hard and soft denials
It might sound strange, but not every denial can severely injure your practice’s bottom line. Hard denials usually end up as written-off revenue that impact your practice’s financial and functional stability.
The most common denominators of hard claim denials are- uncovered services (this is especially true in fertility billing as the coverage benefits vary from state to state), incorrect bundling or unbundling of claims, missing prior authorization information and delayed filing of claims.
Soft denials on the other hand are just a temporary setback to the revenue cycle and can be resolved with consistent follow-up from the provider’s office.
Rate of partially denied claims
Partially paid claims, if go unnoticed, can turn into snowball draining a huge portion of your revenue. The number of unpaid claims against the total number of claims submitted will give you an idea of the percentage of pending reimbursements vs paid reimbursements. Analyzing these factors will help you eliminate the underlying factors of partial claim denials in your fertility billing services.
Coding related denials
Inaccurate codes in your fertility billing practices are a major reason for claim denials. Accurate coding basically forms the backbone of the revenue cycle management process. One misplaced code or incorrect code in billing can lead you to claim denials. Therefore, it is essential for you to monitor and track the coding inefficiencies within the process.
Insurer specific denial reports
When it comes to fertility billing, different insurer guidelines create confusion for the providers. On top of that, the coverage and benefits vary from state to state that incurs more difficulties in claim submission and obtaining reimbursements.
Therefore, insurer-specific denial reports will help you identify the process gaps and help you take corrective measures.
Strategies to Eliminate Recurring Fertility Billing Denials
To increase revenue for a healthcare organization one needs first to understand the difference between hard and soft denials. Some denials imply lost revenue streams, and some imply insurance misclassification. Not all denials result in a negative effect on a practice’s revenue flow. In fact, some verdicts simply have to be repudiated by the primary payers for the secondary insurance payers to pay.
Here are some of the strategies through which you can eliminate the possibilities of denials in your fertility billing process-
Verify insurance coverage and benefits of the patient each time of visit
- Obtain prior authorization
- Make sure the information provided in the document is comprehensive and explain the patient’s condition in detail
- Review codes before claim submission
- Submit the claim according to payers’ timeline
- Train and educate your staff to stay updated on the latest coding and billing guidelines
- You must maintain robust follow-up and appeal team in your fertility center to ensure a streamlined workflow along with accurate and timely reimbursements
To Summarize
Denial management in fertility billing is a critical process that significantly impacts the financial health of your practice. By understanding the key metrics in denial management and implementing the best practices, you can prevent the situation and sustain the financial health of the center.
Outsourcing fertility clinic billing is another resort which increases efficiency, productivity and cashflow within your practice.
At Sun Knowledge, our team of revenue cycle management experts, specialized in fertility billing, can provide you with end-to-end administrative support.
While the consistent skill shortages and skyrocketing wages are pounding you repeatedly, our team of trained professionals can work as an operational extension of your practice at just $7 per hour.
Also, unlike some of the companies who offer fixed packages, we provide you with curated services as per your requirements only.
With industry comprehensive practices and process automation, we help you eliminate errors and prevent denials.
Have more queries? Call us at (646) 661-7853 today to learn more about what makes us the best fertility billing company!