Due to the continuous healthcare reforms like: payers’ policies, regulatory changes as well as ever-evolving billing guidelines. The efficient management of medical billing services has become a major challenge for healthcare providers.
Because due to the growing complexities in the healthcare sector, claim denials have become a common phenomenon in almost every medical business. If the denial rate exceeds the specified limit, it negatively impacts the healthcare revenue cycle management.
And medical practitioners can face critical challenges such as: revenue loss, cash flow disruption etc. Therefore, you should implement smart medical billing solutions to keep your claims process tight.
It’s pertinent to mention here that, the denial rate represents the percentage of medical claims being denied by the insurance companies. Healthcare practitioners should strive to keep their denial rate below 5%. Because the low claims denial rate indicates the streamlined cash flow.
If you are losing a significant amount of revenue due to the high percentage of denied/rejected claims. Then it’s an indicating sign that you should outsource your medical billing services to a well-reputed and professional billing company.
Outsourced medical billing specialists help you to keep your business afloat by optimizing revenue collections management. They identify the root causes of claim denials and then implement modern medical billing solutions to streamline the cash flow of your practice.
Why Claims Are Being Denied?
Here are the following major reasons that lead to claims denials/rejections.
- Incorrect patients’ demographic information.
- Inaccurate/Missing medical codes.
- Inappropriate forms filling, missing modifiers, wrong plan codes, incorrect or missing social security numbers.
- Using medical codes for more expensive medical services than actually performed.
- Duplicate billing.
- Services not covered by the payer.
- Late submissions of medical claims.
How Can Outsourcing Medical Billing Services Avoid Claim Denials?
The innovative medical billing solutions i.e outsourcing allows healthcare providers to streamline the revenue cycle management by keeping the denial rate minimal.
By collaborating with a top-notch medical billing company, you get access to a large talent pool including certified and professional medical coders and billers. They build effective denial prevention strategies after understanding your current RCM system.
First of all, they identify the root causes of claim denials. Then they take further actions to remove the inefficiencies in the medical billing system. They ensure efficient claims management by ensuring:
- Accurate Coding
As we all know that, in-depth knowledge of billing and coding guidelines is crucial to ensure the submissions of clean claims as per industry standards. Because there are many medical codes that you commonly bill for may be modified or deleted. If you process the medical claim with an outdated or invalid code, your claim will be denied.
Therefore, off-shore billing agencies conduct regular training sessions for their billers and coders. So they can update their skills and knowledge according to the latest evolutions in the healthcare industry.
Moreover, they always ensure the availability of the most updated versions of coding books. This enables them to translate the patients’ diagnosis, treatments and medical services into standard codes, without any error. As a result, claims get processed quickly by the insurance companies and leads to faster reimbursements.
- Timely Submission of Clean Claims
Outsourced billing specialists implement effective medical billing solutions to manage medical claims efficiently. They carefully monitor the medical claims throughout their journey in revenue cycle management. Before submission, they double-check the medical claims to make sure that they don’t contain errors such as: incorrect patient’s name, date of birth, gender, age, insurance information or wrong medical claims.
In addition to this, they strictly follow the claims formats and time limits of insurance companies. And make sure that medical claims are submitted in a timely manner, which prevents rejections/denials.
Hence by outsourcing medical billing services, you can not only prevent the claim denials. But also get rid of the excessive burden related to the non-medical obligations of your healthcare business.
