- August 26, 2024
- Posted by: David Smith
- Category: Physician Billing
Whether it is in love or insurance claims, denials always hurt.
With time, claims are getting complex. Volumes are increasing. Insurance companies often change their rules and guidelines for claims submission. No matter how much you try to improve the overall physician billing process or delegate more staff members on denials, without the right strategies, it is impossible to avoid claim denials.
The truth is almost 12% of all claims are denied and almost 50% of healthcare providers reported a surge in denial rate over the last few years.
For your physician billing team, denials are a significant problem. To handle denials properly, you must examine your workflow holistically. You need to identify all the bottlenecks and eliminate each one of them individually.
To manage denials efficiently, you should implement the strategies mentioned below.
Strategies to handle denials in physician billing services:
1) Use the right reporting mechanism:
How effective is your denials reporting? It might seem like a simple task, but it is where many organizations hit roadblocks.
Accurate analytics are essential to truly grasp what is happening with your denials. With the right insights, you can pinpoint the types of denials, uncover the root causes, and measure the impact in terms of volume and cost. Your reporting should break down data by payor, denial type, denial and remark codes, age, and dollar amounts.
Your EHR might have pre-built reports, for instance, offering dashboard tools that can help—but getting the most out of them may require collaboration with your analytics team to tailor the setup for your specific needs.
2) Solve each problem holistically:
Can you tackle a group of similar denials in one swift move? If you identify a pattern of denials that can be resolved collectively, assign a dedicated person to handle the issue. Their goal should be to not only clear the backlog but also develop a plan to prevent it from happening again.
For instance, if you notice too many denials related to incorrect billing codes, appoint someone to correct them and work with the billing team to implement a long-term fix.
For more complex or widespread issues, especially those that violate contract terms, bring them to your managed care department. Instead of sending the same appeal letter hundreds of times, involve them in crafting a strategic, comprehensive approach to address how a specific payer is handling certain claims.
3) Efficient denials routing:
Ensure your EHR is set up correctly to efficiently route denials. The last thing you want is a pile of denials dumped in one place with no way to filter or focus on what matters most. You need a system that helps you quickly identify, prioritize and assign denials to the right team members.
For example, imagine your EHR automatically groups denials by type—let us say you have a lot of eligibility denials and missing document requests. By routing them to team members who specialize in resolving those issues, you can streamline the process and handle them more efficiently.
You can further optimize by organizing denials based on factors like:
- Denial types
- Team members with specific expertise in those areas
- High-dollar claims
- Time-sensitive cases
Even if only one person handles denials, auto-segregating those by type will boost productivity. The key is creating a prioritization system tailored to your organization’s unique mix of payers and challenges. This allows you to see the bigger picture, focus on urgent claims first, and work your way down the priority list with greater efficiency.
4) Assign the right people:
Managing denials is a challenging and time-consuming affair. Handling denials needs the expertise of subject matter experts. Getting the right hands on the right claims—fast—is the key to mastering the art of medical billing denials.
Some denials require deep industry expertise or advanced system know-how, so make sure your most skilled people are handling the toughest cases. Avoid setting up a new team member for failure by assigning them complex clinical or medical necessity denials. Instead, align your staff based on their strengths and experience. Not only does this improve outcomes, but it also creates a clear career path for your team—allowing them to specialize and grow into more complex roles over time.
5) Identify trends:
As your team works through denials, it’s crucial to track why they’re happening. Identifying common issues can help you fix problems and share solutions across your organization.
According to an HFMA survey of over 350 healthcare leaders, here are the most frequent causes of initial payer denials:
- Errors in patient access/registration (eligibility or missing prior authorization)
- Lack of documentation for medical necessity
- Missing or incorrect patient information
- Physician documentation problems
- Utilization management issues
- Coding mistakes
- Duplicate claims
- Late filing
6) Patients’ involvement:
Sometimes, denials require reaching out to patients, especially when there is coordination of benefits or coverage issues. Sending a letter or making a quick call to involve the patient can speed up the appeals process.
This also strengthens your relationship with the patient, showing that you’re advocating for them. Share what you know about the claim, why it was denied, and what needs to be done.
Often, staying on the phone with the patient while calling the payer together can resolve the issue immediately. For higher-dollar claims, that extra effort can really pay off.
7) Track and update missing information:
Denials often happen simply because your system isn’t updated in time or details get overlooked. For example, you might be missing information or enrollments for a new provider when billing, but you still need to submit the claim to meet the filing deadline.
Tracking what you are waiting on and any deadlines is crucial, though it is usually done through system queues and manual reporting. Once you have the missing info, you can update the records and resubmit all the denials together.
Read More:
Top 7 Must-Have Qualities for a Physician Billing Company
Battling Physician billing issues? Outsource to reclaim your time and energy for patient care. Discover what qualities to look for in a Physician billing company. Learn more!
Outsource denial management:
A lot of physicians, these days, are outsourcing their denial management to third-party professional physician billing companies to amplify overall revenue and focus more providing better patient care.
If you are looking forward to working with a perfect physician billing company, look no other than Sunknowledge.
At Sunknowledge, we’ve perfected cash-flow management and physician billing support, setting us apart from other RCM companies. Our team can reduce your operational costs by up to 80% while ensuring your billing process is smooth and compliant with payer standards. Choose us to boost your financial reserves and experience the difference our expertise makes.
Contact us to discover why we’re among the industry’s best.