Claim denials and the medical billing staff's approach to these denials can be the difference between average and outstanding collection rates. The basically philosophy is "pro-active" versus "re-active."

The majority of medical billers are already overwhelmed by an endless number of claims management and medical billing tasks. The most common process is insurance payments arrive and the medical biller posts these payments. Insurance denials are often flagged and put to the side to come back to at the end of the week or, a later time.  The problem is that most commonly these denials never get worked and money ends up building up in your accounts receivable. This is an all too familiar tale. Sometimes these denials are an easy fix but often times they are complicated. It's very difficult for physician offices to incentivize their employees to scrutinize these denials.
Understanding that many, even most, claim denials can be reversed critical. Rather than letting a denial sit it should be reviewed and worked at the time of posting.

Here are some tips for avoiding common errors:

• Once payments are posted start with your first denial. Review the denial code and see what it translates to. Never be afraid to ask someone. Use an online forum if necessary.
• Is the denial is related to timely filing be sure to check your clearinghouse reports to see when it was first submitted. Many times these timely filing denials can be overturned with proper documentation.
• If there was a diagnosis code or procedure code error consult your EMR software system to verify the service provided.
• Many claims can be reprocessed and modified over the telephone. Don't be afraid to pick it up, it will pay dividends. Always be sure to document who you spoke with, their extension, and a reference number if available.

Contact us today, 877.672.6221 if you could use help with your medical billing.