5 mins read
May 17, 2022
Claim rejection or denial causes trouble for both practices and the patients. Staff who are involved in generating revenue for their practices may be tasked with claim and denial management and improving clean claims.
To successfully manage it, one should know that achieving a clean claim isn’t just the requirement, but also should know about the reasons behind those claim rejections and denials and also the strategies or methods to avoid them beforehand.
Here we have given you the points to help you reduce medical claim denials and rejections. You can learn the common possibilities or reasons for claim rejections and denials to update and upgrade yourself and your process to improve the rate of your clean claim.
It usually contains one or more errors that were found before the claim was ever processed or accepted by the payer. A rejected claim is typically the result of a coding error, a mismatched procedure and ICD code(s), or a termed patient policy.
These types of errors can even be as simple as a transposed digit from the patient’s insurance member number. Providers use these detailed medical records to validate their reimbursements to payers when a conflict with a claim has been issued.
These are medical claims that have been received and processed by the payer but have been marked as unpayable. These “unpayable” claims typically contain some sort of error or lack of prior authorization that became flagged after the claim was processed.
Some of the issues for denials may include missing information, non-covered services per plan, or even not medically necessary services.
Have you ever thought about the reasons behind these unfortunate situations? We know you would have for sure. These reasons may look silly to others but even a small matchstick can cause chaos in the forest.
Let us show you some of the main causes among a wide range of these claim denials or rejections.
The crucial thing for effective revenue cycle management (RCM) is the assistance of clearinghouses with denial management. The clearinghouse software secures electronically protected health information (ePHI) by sending claims and financial information electronically to insurance carriers, securely.
Rejected or denied insurance claims can cause disturbances in the financial workflow of a practice or a healthcare organization. Claim and denial management must concentrate on reducing these by knowing the reasons and working on them effectively.
CapMinds Medical Billing and Coding services are here to rescue you from denials and rejections of claims. Our medical billing team expedites your entire billing process. We optimize your charges, submit your claims, on-time collection, reduce accounts receivables, identify underpayments and increase your practice’s net collections, thereby better clinical and service expansion.
Our insurance verification feature ensures that your patient’s insurance plans are verified to prevent rejections and delays in payment. Our denial management deals with contacting insurance plans, refiling claims, and submitting appeals for the denied claims.
Our service includes AR follow-up, credentialing, patient billing, reporting, virtual assistance, etc.
Make sure you avail all the advantages of our service and enjoy an uninterrupted financial workflow.
“Let’s reduce your claim rejections or denials effectively, together”