Claim denials are a common issue many healthcare providers deal with, and they can affect a practice’s profitability. Denials or claim rejections happen when health insurers refuse to settle bills for services rendered to an insured patient. Medical billing services can help reduce the incidence of such claim rejections, improving your practice’s profitability. Here’s how healthcare billing services can help with claims denials:
Create Accurate and Timely Claim Submissions
Submitting claims with inaccurate information is a common reason for denials. Health insurance companies often vet information on claims before settling them and can identify such incorrect information. Healthcare billing providers can help capture services rendered accurately on claims before they are submitted. They may also assist with timely claims submissions to insurance companies, reducing the risk of claim denials.
Verify Patient Insurance Eligibility
Insurance companies will only pay for medical services per their agreement with the patient. Medical billing services can help make sure patients are eligible for the medical personnel’s services. Insurance eligibility verification can be done before a patient is treated using phone calls to the payer or online portals. Once they have verified that a patient is eligible for the medical services under their coverage, medical professionals can schedule them for services.
Review and Correct Claim Errors Before Submission
Documentation errors and inconsistencies can happen within medical institutions, often resulting in claim rejections. Healthcare billing providers can use manual methods or digital software to check for claim errors. Reviewing and correcting clerical errors on claims before submission can help reduce denials. Attention to detail about patient records and treatments can also make certain services are charged correctly to help prevent financial loss. Billing service providers use software to track documents and prevent duplicate claims or charges that may result in denials.
Obtain Prior Authorization For Procedures
Some insurers may insist on patients getting prior authorization for some procedures. Healthcare billing services can contact the relevant insurance companies to get pre-authorization ahead of such procedures. This can help make sure the insurer and healthcare provider are on the same page to avoid claim denials after the procedure.
Make Sure Claims Meet Coding and Billing Regulations
Coding and billing rules and regulations govern medical record keeping and documentation, which play a significant role in claims processing. These rules and regulations may change often, but healthcare billing services can help your practice keep track of such changes. Healthcare billing providers make sure all claims are filed according to the latest coding and billing standards. This can help reduce medical coding errors or missing modifiers that may result in claim denials.
Follow Up With Insurers and Appeal Denials
Delayed claims can affect the financial well-being of a medical practice. Healthcare billing providers track the progress of claims to avoid delays in claims payments. They communicate with insurers about pending claims and help resolve issues that may have com up during processing. Following up with insurers can help reduce the risk of claim denials due to misplaced claims or payer errors, promoting your medical practice’s profitability.
Work With Medical Billing Services
Claim denials can hurt your medical practice’s profitability, so consider seeking expert help to avoid rejections. Medical billing services can help prevent claims denials by verifying patient eligibility and obtaining pre-authorization before you render services. They can also follow up with insurers to track pending claims and correct arising issues for a faster processing period.