12 Tips on How to Avoid Claim Denials in Your Practice

Touseef Riaz

November 14, 2022

How to Avoid Claim Denials in Your Practice?

In a recent survey, the American Medical Association (AMA) reported that an average of 24% of all medical claims go unprocessed. This means millions of dollars are lost annually due to denials and improper documentation. So, suppose you are thinking about How to Avoid Claim Denials in your Practice? in this blog post. In that case, we will discuss ways to avoid claim denials in your Practice by using more effective methods for documenting patient encounters.

How to Avoid Claim Denials in Your Practice?

How would you go about bringing down the percentage of denials?

Below are some of the steps you can take to bring down claim denial: 

ICD-10 codes and CPT codes 

The first action to take to prevent claim denials is to know your medical coding rules, which are often buried in the back of your manual or online repository. In addition to being able to identify what type of documentation you need for each procedure, it’s also vital that you understand how this information affects your ability to receive payment from insurers (and even if they will pay). For example, suppose multiple similar procedures have different diagnoses or conditions. In that case, it’s essential to document these separately and understand how much time those services take versus others on the same page. For example, if one service takes 30 minutes and another takes 15 minutes—which would be considered outpatient vs. inpatient? Or does it matter at all? It does matter! This depends on where someone went after leaving their primary care provider’s office; however, most providers don’t keep track, so we’ll have fun guessing here

Charge accurate ICD-10 codes and CPT codes

If you owe a billing insurance company, it is essential to use ICD-10 and CPT codes. ICD-10 is the latest version of the International Classification of Diseases (ICD) from the World Health Organization and was published in 1992. It has replaced ICD9 as an international standard for medical coding and billing.

CPT stands for Current Procedural Terminology, and HCPCS stands for Healthcare Common Procedure Coding System; healthcare professionals use both to classify patient procedures. The two systems have similar purposes but differ in some ways, such as how they define specific diagnoses or operations performed on patients with different conditions that require other treatments depending on where one falls within these categories. Hence, it is essential to charge these accurately to avoid denial management in healthcare

Check patient demographic information

There is no way around it: your claim will be denied if you don’t have the correct patient information. This is why checking your patient demographic information before submitting a claim is essential. If the name isn’t right, the system won’t accept it, and you’ll get a denial in return.

Moreover, if you’re unsure about what other information should be included on each form (i.e., address vs. SSN), ask yourself these questions:

  • What kind of insurance company do they have?
  • How long has this person been covered under my plan?
  • How old was this person when they first joined my plan?

Duplicate claim or service

  • Make sure you are using the right CPT code.
  • Avoid duplicate claims or services in your Practice.
  • Consult your insurance policy to determine if any services are not covered and charge accordingly.

Attach the proper medical documents

When it comes to claims denial, the first thing that a provider must do is ensure that they have attached all of their required medical documents in the correct order. This helps ensure no discrepancies between what you’ve submitted and what your insurer deems acceptable.

The order of these documents is essential because each section of your medical chart needs to be matched up with its corresponding code from CPT (Current Procedural Terminology) or ICD-10 (International Classification of Diseases). For example: if you have been diagnosed with pneumonia using ICD-10 code J18.5, this code should be included in all future medical reports and any correspondence related there because this information could lead back too far into history.  

Provide complete documentation

  • Provide the proper documentation for the correct claim.
  • Documentation is required for all claims, regardless of whether or not they are contested or settled.
  • Documentation must be legible and readable by a physician or other health care provider responsible for making decisions for your Practice (such as an insurance company). The information must also be in English so anyone, including yourself, can understand it!

Leverage technology

If you want to know How to Avoid Claim Denials in your Practice? So another important point that you can consider is leverage technology. Technology can help you manage your denials and understand and learn from them. Moreover, it also helps prevent future claims from being denied, automates your workflow, and improves revenue cycle management.

The following are some examples of how technology can be used to reduce claim denial rates:

  • Claims management software: This online solution allows providers to enter patient information into a database system where it’s stored securely until necessary tasks, such as sending notices or payments, are completed (such as submitting an insurance bill). The software also provides real-time reporting capabilities so providers can track the total number of claims processed per day or week. Hence, this data helps identify trends over time so they know what areas need improvement if they want lower denial rates down the road. 

Document accurately and appropriately.

Your documentation should be clear and concise, providing a good description of the services, patient condition, medical history, and insurance coverage. Moreover, give an accurate description of all services (including dates). If you are using a billing service or other third-party vendor to submit claims for your Practice, ensure that they have verified with their provider network that all charges were correct before submitting them to payers or insurers. It is a great way to avoid denial management in medical billing. 

Double-check before you submit the claim.

Always double-check that you have all the information needed to submit a claim. You should be able to find this information in your policy or contact the company directly. Make sure that all information is correct and that all deadlines are still within reach.

Don’t miss important deadlines. 

You should always make sure that any deadlines for submitting claims are still valid. These can include deadlines for reporting incidents or damage, as well as deadlines for filing claims with your company or making payments on time. If there are any missed deadlines, they will most likely be denied and could result in additional penalties or even the termination of your policy altogether!

Learn from former denials.

Once you’ve dealt with a claim denial and are ready to move on, look at the medical documentation submitted with your claim. Are there any errors in it? Was there any missing or incomplete information on the form? Is there anything that could have been done differently when documenting patient care?

If you find any issues like these, ask yourself if they would have made a difference in getting paid for services rendered. If so, make sure they don’t happen again!

Optimize claims management software

The best way to avoid claim denials is to have a well-managed claims management process. Claims management software can help you manage your claims, identify issues and fix them, track denials, improve your Practice’s methods, and more.

Claims management software allows you to:

  • Manage multiple accounts in one place
  • Track the history of each client’s past claims so that they don’t get denied again

How to Avoid Claim Denials in your Practice?—Three common reasons:

Services are reported separately

Some procedures should not be bundled together. It’s also crucial to keep in mind that doctors could work for a company that isn’t covered by a patient’s insurance, so certain services shouldn’t be bundled together. By being familiar with the services offered to the patient and the bundling policy of the payer, a professional medical coding and billing provider can reduce claim denials and the requirement for coding adjustments. 

Improper modifier

Improper modifier use can lead to denials and improper reporting and payment due to inaccurate reporting information; this is why coders and billers need to familiarize themselves with all modifiers to know when they’re applicable to avoid errors in reporting data. 

Stop claiming denials

You can avoid claim denials in your practice in medical billing by using the following steps:

  1. Add a claim to your file that is deniable.
  2. In the claim, explain why you are making this claim, including any evidence you have that supports your claim.
  3. Include all your documentation with your claim and ensure it is legible and correctly organized for filing.

Turn those denials around.

Denial management is a vital part of your Practice’s revenue cycle management. It’s the process of managing denials and getting those claims paid.

To avoid claim denials, you must have a good denial management process. A good denial process will help your claims manager track what’s going on with each denied claim. Hence, this way, they can address the issue immediately when they come up again later on down the road.

Conclusion:

In short, if the above guidelines have answered your question, How do you Avoid Claim Denials in your Practice? With the right tools and proper documentation, your practice can turn around denials and drive more revenue. And it all starts with a good Denial Process. U Control billing can help you build that quickly and easily.  

 

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