What are Rejection and Denials? 2022 Strategy:
How may medical practices and billing firms better comprehend claim denials and rejections? How can they avoid the same rejections and denials recurring again and again? These are two of the questions we asked denial management solutions expert Elizabeth Woodcock, MBA, FACMPE, CPC, who will be presenting two webinars for Bellmedex on the topic of attaining clean claims in 2022.
She began by outlining the various stages of the claims process. Problems with clean claims can arise at the entry of a charge – or months later, when the insurance company adjudicates your claim. It’s critical to enter data accurately, preferably utilizing electronic claims submission software, which allows you to amend problems before filing the claim.
Measure the Number of Denial Claims:
Denial management Solutions is required to track and report claim denials. It will also necessitate entering your denials in order to report on them. If your medical practice accepts payments electronically, you’ll already have this information. If you don’t use electronic payments or if your payers don’t all accept them, you’ll have to manually enter denied claims (zero payment remittances) into your practice management system.
Identify the Reason of Denied Claims:
To tally the number of denials by cause, you must first decide which categories you will use to keep track of all of your claim denials. The following is a list of the most common medical practices denial reasons medical practices.
Don’t be afraid to make changes to this list. You may discover a new category as you grow more familiar with your denials. I recall the first time I kept track of denials in my medical practice. We had forgotten to put “information from patient” in our list of reasons. Our billing staff kept questioning, “What category are we using when the payer won’t pay us because the payer lacks some information from the patient? We hadn’t recognized how frequently this was happening, so we created the category so we could track the amount of claim denials and figure out how to contact our patients and payers about it.
Find areas of Opportunity:
Each error or denial is an opportunity to enhance your process and increase the percentage of clean claims. Woodcock, on the other hand, claims the exact opposite. They can be fun challenges for everyone in your company. If you see a lot of “subscriber not eligible” on your reports. For example, it’s time to examine your front-end procedure.
This might involve having the scheduler use real-time eligibility checks at the time of the appointment. It takes effort and training to change this procedure. But it has the potential to increase the number of clean claims. Billing businesses can assist their clients in determining what problems are recurring and recommending a process modification if necessary.
During Denial Process Engage the Team:
Distribute the reports. Request that the team identify the areas that need to be changed and make recommendations for how to tackle the problem. No one has a complete picture. Then incorporate the team in the results, both good and bad, and include them in fine-tuning the steps to success. Celebrate with your friends and family.
Do not attempt to solve all Issues at once:
Run the reports at the start of each year to select four areas where you wish to improve that year. Real change necessitates thorough consideration and retooling of processes, as well as people and technology. Don’t put too much pressure on your team. Analyze each area of change thoroughly before working on it till it’s up and running. A practice might evaluate eligibility checks one quarter, clearinghouse rejection codes the next, referrals/authorizations the third, and medical necessity the fourth. Break them down into subtasks if they seem too big to handle all at once.
Be Patience during denial management solutions:
Expect no immediate results from your adjustments because the billing and payment procedure is delayed by operations. It usually takes 90 days to see if enhancements to the rejection and denial management processes the desired results. It could take several months before you see positive financial results.
About Bellmedex Denial Management Solutions:
Bellmedex is a medical billing company based in the United States that provides skilled denial management solutions, electronic health records, and best medical billing services for faster claims processing and higher reimbursements. You can keep track of and manage your practice on the move with Bellmedex’s comprehensive spectrum of services and EHR. Our dependable services optimize operations and provide efficient practice management by automating workflows and claims processes.