How Medical Practices Are Reducing Claim Denials Without Hiring More Staff

Claim denials are one of those issues that affect practices more than most people realize. A claim denied isn’t only a claim that won’t be paid; it’s one that staff will have to track down, figure out, appeal and wait again. That process spends hours of staff time, and when time is already limited in a struggling operation, those hours add up quickly.

And it’s getting worse. With changes in insurance requirements, updates in coding every year, and the inclusion of more and more minuscule details, any typographical error from a patient could flag an automatic denial. It’s become the worst option for a practice to turn to as they either have to hire more people to bill (very costly) or watch their revenue cycle crawl (still costly). Yet there’s another option, one that more practices find themselves succeeding with.

The Real Impact of Claim Denials

Most practices understand that denials cost money, but the real picture is worse than expected. Denials generally run average rework costs of between $25 and $117, depending on the service complexity. That doesn’t also account for extended cashflow or potential rework for claims that never get reworked at all due to staff run out of time.

It’s not only about the money. When staff are constantly faced with denials, they become burnt out. Instead of looking at preventative care, they’re stuck doing repetitive damage control. When patient experience is suddenly weighed down by extensive billing issues, the heaviest atmosphere could have been prevented.

Where Denial Issues Truly Stem From

What many practices fail to realize is where most denials occur, before they even get sent. Wrong patient demographics, missing authorization numbers, wrong insurance from the get-go. The front desk makes mistakes that send issues backwards into the billing cycle.

And then there’s coding. Coding takes place frequently, updates galore and no one wants to utilize an old coding system without a new modifier to apply; claims bounce back with rejections because insurance companies don’t want to play guessing games when it comes to approval.

And finally, the final verifications get the best of many too. When staff fail to verify before the appointment that coverage exists, they render the service pointless at times, creating denials galore as awkward conversations emerge between practice and patient later on.

How Practices Fix This Without Staff Expansion

Right now, the streamlining transition is simple: they take on help without taking on employees, per se. A medical billing assistant for private practices provides everything necessary for claim submission; denial follow-up; and ensures the revenue cycle moves continuously without in-house staff expansion expense.

It works because not all work has to be done in-office. Unlike clinical work where an employee has to show up to effectively work, billing can be done remotely, facilitated through systems in place effectively providing practices focused attention from someone dedicated to keeping claims clean.

The Preventative Approach That Works

Reducing denials has nothing to do with fixing more errors; it has everything to do with making fewer errors in the first place. Those practices having seen real change focus on front-end accuracy through enhanced patient intakes, extensive insurance verification prior to appointment and additional care efforts to ensure all documentation gets submitted with claims from the start.

Some have begun scrubbing where they review claims before they get submitted. If issues can be caught here, less time gets wasted on denials down the line. When someone is dedicated to looking through submissions for common reasons rejection occurs, percentage rates decrease tremendously.

Real-time eligibility checks go a long way while they’re on the phone, this curtails potential issues down the line and while it’s one extra thing that seems menial in the moment but time-consuming later on, it’s worth it.

What’s Different When Billing Consistent Attention is Paid

When billing tasks are assessed by someone who is strictly doing it all day, patterns emerge; they know which insurance companies reject which codes regularly, what documentation request goes by the wayside most often and where the real bottlenecks occur.

Follow-up also becomes substantially more common; denied claims aren’t sitting around waiting for someone to take time, submission responses are timely taken care of as follow-ups when no one remembers why they got denied.

Cash flow improves as resubmission occurs because resubmission happens faster. The revenue cycle moves with much more expediency when processes are handled outside of the eyes of those constantly bogged down by other responsibilities.

Finally, practices notice less in-house staff burnout when front desk personnel aren’t attempting to take care of billing in addition to their other positions. When they’re clear on what they’re supposed to do, operating a happy patient atmosphere, the day goes smoother.

Making the Transition

Any effort means a transition period, but new practices take time to acclimate their new support staff for billing operations all day getting them up to speed on diagnoses common and preferred processes prevent hiccups down the line.

Documenting becomes critical when someone isn’t in-house. Thus, thorough clinical notes must be made, with clear codes noted so that billing notes can get taken care of efficiently; it’s a team effort, even for part-time teammates.

But the pay-off happens quickly, as little as months later as their denial rates drop, even cash flow improves for quicker processing rates once trials become routine efforts instead of new attempts at every turn. Getting set up properly pays off when revenue becomes reliable once again and staff can breathe freely.