How a Medical Billing Service Firm Helps You Prevent Denials

Katleen Quiros • Jul 27, 2021

Healthcare providers know that medical billing denials are frustrating. It hinders your cash flow and eats away your bottom line. Processing it over and over again wastes a lot of time and effort, resulting in poor cash flow. Due to this, medical practices must ensure that medical billing is correct. Read more to learn the common reasons your claims are denied and how to prevent them from happening again.

Common Reasons for Denied Claims

Below are common reasons for claim denials:

Invalid medical codes
Lack of payment credentials
Incorrect database entries
Patient identification problems
Health insurance coverage is unverified or terminated.

Thus, these deficiencies can lead to a negative impact on medical service provider's practice. However, there is the best resolution to at least reduce denials. With the assistance of a medical billing service firm, your revenue is stable and secure. Creative billing methods and techniques resolve medical billing denials.

How to Prevent Denials

Here are effective ways to prevent denials:

Monitoring Medical Billing Denials

Medical billing firms always check reviews of medical billing denials. Moreover, they keep track of percentage denials deeply so that they can fix the issues. The financial criteria also require resolving the conflicts within a time frame.

Quality improvement of patient data

Data quality in healthcare is the main point for healthcare providers. It is always a requirement to maintain the accuracy, reliability, and consistency of data. For this reason, the application of healthcare data analytics has a lot of positive and life-saving outcomes. Here are the following approaches to ensure data quality:

Installing protection against data fudging
Training and conducting internal audits
Using error-detection software
Verifying computer systems
Maintaining backup and recovery systems
Ensuring physical security
Setting up audit trails

Overall, a reliable medical billing services provider can also assist in updating your patient data regularly. They should stay up-to-date on the latest policies and help you ensure proper documentation. Therefore, the chances of preventing denials are big and reduce the source of errors. Data should be accurate, up-to-date, and organized to maintain a clean system.

Error-free coding

The cases of denial claims in medical practice are increasing because of:

Current Procedural Terminology (CPT) coding guidelines
Introduction of ICD-10 diagnostic codes
Complexities of the patient's medical records
And coding errors

Indeed, a professional coder is the best staff to reduce coding errors. Before submitting the meeting form, the claims expert reviews it to make sure there are no gaps or mistakes. In this case, medical billing services firms implement these ways to avoid coding errors:

Avoid duplicate billing.
Make sure you're using the latest medical coding regulations
Ensuring patient information is accurate and correctly aligned with data.
Always double-check insurance benefits and coverage in advance.
Never submit a claim with an incorrect billing code to increase reimbursement.

The most effective way of avoiding code errors is by taking note of the diagnostics and service codes. Guide sheets must also be accessible to all coding and billing staff when evaluating claims.

Electronic Health Record (EHR) Backup System

Professional medical billing services providers, such as DrCatalyst, prioritizes the backup system of records of millions and trillions of patients. Our medical billing experts don't only keep records but also protect and secure them at all costs. Besides being automated of everything in the medical industry, we also use high-tech secure servers and the newest software. Importantly, we follow the mandatory standards of the government and HIPAA - Health Insurance Portability and Accountability Act.

Monitor changes in Medical Guidelines or Insurance Plans

By keeping abreast of industry updates, policy changes, and new medical billing criteria, medical billing companies ensure the reliability of the billing processes that they apply to each medical provider. It is always important to remain updated on insurance changes to get more approved claims. In addition, they always assure to keep track of any aspects that will assist in improving medical billing services.

Consult the Experts

A Medical Billing Specialist analyzes, prioritizes, and identifies tendencies of denials for your practice. In addition, it is up to you to determine the resources necessary to apply solutions, prepare reports, and track progress.