3 Tips for Reducing Claims Rejections and Denials!

1. 3 Tips for Reducing and Denials - Unify Healthcare Services

2. Documentation, coding and billing are complex processes, and rules can vary depending on the payer, patient, and procedure. Even the most meticulous offices experience claims denials. By knowing the most common denial reasons, you can take steps to avoid and reduce claim denials.

3. Ineligibility accounts for 24% of all denials. Even if a patient has been coming to your practice for years, people change jobs—and plans. Check that the patient’s coverage hasn’t been terminated, their maximum benefit hasn’t been met, and their plan covers the service you’re providing. Ensure that your staff knows the plans you accept, how to interpret policies, and feels comfortable discussing coverage issues with patients.

4. Just leaving one required field blank on a claim form can trigger a denial. Incomplete information like wrong plan code or no Social Security number accounts for 61% of initial medical billing denials and 42% of denial write-offs. The most commonly missed data points are date of accident, date of medical emergency, and date of onset. It’s also essential that the information provided is accurate, so double-check: Patient name Date of birth Sex Insurance payer Policy number Group number (if required) Patient’s relationship to the insured Primary insurance (in the case of multiple insurances)

5. Authorization and pre-certification issues account for 18 percent of denials. It takes time to learn which services are considered medically necessary, which require prior authorization, and which require referrals. And, obtaining prior authorization doesn’t guarantee payment. The claim also must be supported by medical necessity, filed within the deadline, and filed by the provider noted in the referral or authorization. To stay within the bounds of medical necessity, only perform a procedure if there’s a clear medical reason. Use notes or attach records to support the services provided.

6. Don’t forget to provide documentation feedback to your physicians. Hold in-services to educate them about payer changes and new documentation requirements. Also, inform front-end staff about mistakes and retrain if needed.

7. THANK YOU! Contact Us: : https://www.unifyrcm.com : info@unifyrcm.com : (866)796-0858