5 Tips to Limit Claims Rejections and Denials

Carisse Armada • Mar 16, 2023

Medical billers ensure that providers receive payment for their services. Inevitably, both human and electronic errors occur. Due to the personal and financial nature of medical billing, it's crucial to reduce errors as much as possible. Here are the top tips on limiting your claim denials and rejections.

What is Claim Rejection?

Claim rejection refers to situations where your insurance company does not pay your healthcare claim, either in part or full.

A claim rejection occurs when your insurance company finds an error in your submitted claim. The claim is then returned to you with details of the error(s) you can correct and resubmit.

What is Claim Denial?

A health insurance claim denial happens when an insurance company refuses to cover a specific claim for reasons we will discuss further in this article.

You cannot refile denied claims, but they can reverse their decision if you file a request. It would help if you looked into why these are being turned down by now so you can write an appeal for reconsideration or an appeal. When managing medical billing, it's essential to know how to handle claim denials effectively to avoid revenue loss and maintain healthy cash flow.

Also, you must include an appeal request for your AR denials with the claim you submit. This is necessary to avoid rejecting your claims because they can be at risk of being similar to those of other claimants.

What Are the Common Errors When Submitting Claims?

Healthcare providers like yours need to understand the reasons for rejected claims and denials and work to minimize them, as they can result in:

Delayed payment.
Increased administrative costs.
Reduced revenue.

Many different types of errors can occur when submitting healthcare claims. Reducing errors in claims submission requires attention to detail and careful review of all information presented.

Here are some of the most common errors:

Incorrect patient information - Errors in patient information such as name, date of birth, or insurance policy number can result in a claim rejection or denial.
Incomplete or missing information – Medical coding denials will result from missing claims or incomplete information, such as diagnosis or procedure codes.
Incorrect coding - Insurance companies can deny your claim if you use the wrong procedure or diagnosis code. You can also receive incorrect payments.
Non-covered services - A denial in medical billing will occur if the service provided is not covered under the patient's insurance policy. Your medical practice should always verify patient coverage and benefits before providing services.
Duplicate billing - This occurs when you bill the insurance company for the same service twice or multiple times.
Untimely filing - To avoid the most common denials in medical billing, you should submit your claim within a certain timeframe. Take note that the timeframe varies by insurance plan.
Coordination of benefits (COB) errors - COB errors occur when multiple insurance plans cover the patient, and the medical providers bill the wrong method or fail to coordinate benefits correctly.

5 Tips to Limit Claims Rejections and Denials

By following these tips, your medical practice can reduce claims rejections and denials and enhance overall revenue cycle management.

Here are five tips for healthcare providers to help limit claims rejections and denials:

1. Submit Claims Accurately and Completely

Ensure that you include all necessary information in the claim submission, such as

Accurate diagnosis and procedure codes.
Correct patient information.
Verify the patient's eligibility and benefits.
Any required supporting documentation.

2. Submit Appeals Immediately

The most important part of a good denial management process is that your practice can handle claims correctly and resubmit an appeal quickly. Your approach should be quick and flexible enough so you can file a request within a week of getting a denial.

3. Stay Up-To-Date With Coding and Billing Regulations

Keep current with coding and billing regulations changes. This can help prevent denials due to coding errors or non-compliance with billing regulations.

4. Maintain a Systematic Approach

Be organized! Rising rejection rates will cause significant administrative issues. So, set up a system for managing claims and use HIPAA-approved tools and technologies to keep track of the claims.

5. Contract Outsourced Rejection Management Services

As a medical practice, you can supplement internal medical invoicing and coding operations with outsourced services. Through outsourced services, your practice can quickly access a team of top-notch and skilled professionals.

They will apply the latest trends in medical billing denials and solutions to ensure maximum reimbursements and reduce the likelihood of claim denials.

Billing experts will contact patients to collect any data required to settle claims. Before you provide the service, the outsourcing team will decide whether a suggested treatment is under the insurance coverage and obtain approval from the insurance company.

Partner with DrCatalyst

A leading medical services provider for healthcare organizations, DrCatalyst can help you reduce the number of rejected or denied claims. We are experts on claims denials and rejections and will help you in the following ways.