Common Reasons For Insurance Claim Denials
Denials on insurance claims are always very inconvenient for the patients. Additionally, they can affect the ability of the practice to receive payment for the services rendered. Preventing denials before they occur allows your practice to run efficiently by receiving money for any services rendered. It’s also a good way to keep a good relationship with the patients since they will stay loyal to the practice if their claims are paid in time. Of course, to prevent any insurance claim denials, you need to understand why they happen in the first place.
Why Are Insurance Claims Denied?
1. You Waited Too Long To File
Denials on insurance claims are always very inconvenient for the patients. Additionally, they can affect the ability of the practice to receive payment for the services rendered. Preventing denials before they occur allows your practice to run efficiently by receiving money for any services rendered. It’s also a good way to keep a good relationship with the patients since they will stay loyal to the practice if their claims are paid in time. Of course, to prevent any insurance claim denials, you need to understand why they happen in the first place.
2. Your Office Submitted Duplicate Claims
If a second claim is filed before the insurance company responds to the first one, both claims will be denied. If there isn’t an established system in place, multiple employees might submit the same claim. Having an efficient claims submission process will cut down on double filing and can help with denied claims.
3. Your Submitted Claims Are Missing Information
Missing patient information can be an error on the part of the patient or an administrative error on the office staff. Claims are likely to be denied if any patient information is incorrect or missing. Even an incorrect patient date of birth can result in a claim being denied. A system needs to be in place to ensure all information is collected and correct.
Automated billing systems can help to limit human error and increase the efficiency of collecting patient data.
4. You’re Using Inaccurate, or Out-Dated, Coding
There are many advantages for using ICD-10 for medical billing compared to other applications. However, it can get confusing with such a large volume of codes. Knowing what codes to use for payment, as well as when to use them, is the difference between a $40 patient visit and a $120 patient visit. High-quality medical billing systems can be integrated into your practice to help facilitate accurate coding. Most of these systems (like MediTouch) often flag any errors before any claims can be filed thus preventing a denial. Couple this with a comprehensive billing strategy (we have perfected this) can help increase the profitability of time spent with patients.
5. Failure Of Identifying Medical Necessity
Insurance companies often need proof of medical necessity for some procedures. Therefore, failing to produce adequate information will result in denial of insurance claims. If the medical billing software is integrated, it is easier to provide the best documentation for any claims to be accepted.
If you’re looking for the best Houston TX medical billing company, you should contact us or call today for more information.
