How to Handle Claim Denials and Maximize your Reimbursements

April 4, 2022 Medical Billing

It is hard to imagine what the healthcare scene would be like without medical insurance. Medical insurance is, after all, responsible for making health care services accessible to people from all walks of life. That being said, the process that entails claiming insurance and reimbursements can be incredibly frustrating and tedious to undertake with frequent claim denials being a major issue that healthcare organizations and providers face today.

A claim is said to be denied when a health insurance company refuses to pay the submitted claim. Frequent claims denials can affect the financial health of your healthcare organization. We’ve seen practices dissolve because of decreased revenue triggered by high rates of rejected claims.

So it is imperative for a healthcare provider or practice to know how to handle claims. This is precisely what we will be focusing on in this article.

So without much further ado, let’s understand what cause claim denials and how you can avoid or manage them to maximize your reimbursements.

Common Reasons for Claim Denials

The following are some of the most common reasons for claim denials:

• Missing or incorrect information
• Issues with provider network
• Redundant claim
• Inaccurate coding of service
• Non covered services
• No eligibility verification
• Delay in filing claims
• Insufficient medical necessity.

Preventive Measures you Can Take to Reduce Claim Denials

Like we said before, claim denials can diminish a practice’s revenue. Therefore, it is very important to develop a strategic process to identify what may have caused the situation and address it in time to maximize reimbursements.

As such, we believe the following preventive measures can help your practice accomplish that without a hassle.

1. Set up a denial management team

Having a dedicated team that is focused on identifying and resolving claim denials is a great way of handling this problem in an efficient manner. The team can be assigned the role of immediately identifying the cause of a denial, finding a solution to the issue and submitting an appeal on time to make sure the practice isn’t missing out on valuable reimbursements.

Their purpose would be to investigate each cause of a claim denial systematically in a bid to ferret out the root cause. They can then build a process that makes managing claim denials simple in the future.

2. Identify and Sort the Cause of Denial

We highly recommend identifying the root cause of a claim denial and then sorting them into groups. There could be a variety of reasons for a claim being denied. It could be missing information, incorrect billing details, or simple eligibility issues. Whatever the reason, your practice needs to document them and your staff must be appropriately trained to avoid these mistakes in the future.

3. Fast Action

It is recommended to not waste time when you get a notice of claim denial. Instead, you should immediately start working on an appeal that you will submit to make the insurance company reverse their decision. The process of re-submission is a complicated one, and as such, should be undertaken as quickly as possible.

Not submitting an appeal on time will result in your application being rejected for good while your practice suffers massive revenue losses.

4. Monitor Your Denial Management Process

Keeping a record of the denials you’ve received, when you’ve received them and the measures you took to address them, will ultimately help you monitor your effectiveness in dealing with such situations. You’ll know if your team is capable of handling denials, what area they are lacking in and if training would help decrease further errors.

We recommend using visual charts to determine the impact of claim denials on your revenue. You should also work hard to device and implement strategies at every fundamental step of your organization’s revenue cycle.

5. Outsourcing

Finally, if you find the whole process of handling claim denials overwhelming, you can always reach out to DENmaar to handle it for you. DENmaar specializes in end-to-end insurance credentialing, thus helping providers and healthcare organizations get on an insurance company’s panel. We take care of flawless documentation to make sure your submitted claims are clean, compliant, and have little to no chance of being denied.

If the claims are denied, we will immediately submit an appeal to make sure your organization isn’t losing out on hard-earned revenue. Outsourcing to DENmaar will also alleviate the burden of credentialing off of your staff, thus freeing them up so they can focus on providing better care to your patients.

The Bottom Line

All of the preventive measures we discussed above can help your practice avoid the time-consuming and costly denial management process. In fact, you will be able to handle claims more efficiently if you just identify the core reason behind the denial of claims plaguing your practice and use appropriate preventive measures to tackle them once and for all.

These preventive measures can be:

• Including correct patient information and medical records in your application
• Filing claims in a timely manner
• Staying updated on changes in the insurance claim process
• Training your staff in medical billing and coding
• Employing a good EMR (electronic medical recording) system to get access to patient information.
• Verify a patient’s eligibility and insurance before rendering service
• Monitor your revenue generation cycle regularly.