In the medical industry, claim denials are a hectic procedure to deal with. There could be several reasons for claim denials. First, we will look into important factors for claim denials.
Every organization looks for a denial management team to deal with these denials. The team can dedicatedly work on reimbursing the denied claims. There are certain effective principles followed by several top denial management teams.
Reasons for Claim Denials:
When we see a greater ratio of Claim Denials, it shows revenue losses as a result. Therefore it is important to understand the reasons responsible for denials.
- DNFB Issues
Discharge Not Fully Billed (DNFB) is a situation in which the patient is discharged, but the bill is not completely collected. Ignoring this aspect can cause a huge revenue loss. It is noticed that a significant amount of claim denials occur due to the DNFB issue in healthcare segments.
2. Medical Coding Issues
Medical Coding is a very sensitive issue. Your billing process depends upon it. As a medical coder, one has to stay updated on the rules and regulations. Any negligence in this segment causes the claim denial rates to increase.3
Keeping and maintaining patient documentation is a prime role of the healthcare sector. Having incomplete data will be the cause of medical claim denials. This includes their eligibility, past records, and several other factors. Hence do not be loose when it comes to this area of the billing process.
Effective Ways of Dealing With Claim Denials
Once you have figured out the problem of why your claim denial rates are increasing, it’s time for action. You have to look into the solutions to solve each issue.
Outsourcing is seen as the best way to resolve your claim denials. They would have a dedicated team of experts who would study the denials and take appropriate actions. It will help you save time and benefit your organization by reducing the claim denial rates. This is seen as one of the most effective ways of dealing with these type of denials.
If you do not wish to outsource, then the only option you have is to have a dedicated team of staff to manage claim denials. This team will be looking into the reason why a particular claim is denied and take action according to appropriate timelines. They will also have to stay updated with each update in rules and regulations.
The billing processes need close supervision, as any negligence can cause the claim denial rates to increase, affecting the RCM of your organization. You have to ensure that you have a professional medical coder who knows the coding requirements. The coder responsible should be aware of the updated rules and regulations. Any issues in the medical coding will be the root cause of several future issues. Hence ensure that you hire and allot a proper medical coding team for the job.
You have to ensure you have proper documentation to support all your claims. You need to be really sensitive when it comes to collecting and maintaining the required information.
There are always effective solutions to resolve the claim denials, also known as denial management. But it is always better to take precautions in the initial stages to avoid claim denials. The best way is to trust the process in the hands of an expert. Hence outsourcing your medical billing will be a safer and more convenient option.
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