Reducing denials rate and claim rejections are the most ideal approach to ensure faster payment. A rejected claim with mistakes impedes the payment cycle, affecting your practice’s revenue flow . ensuring cleaner claims submission is the best approach to keep away from unnecessary claim rejections, denials and low payments. Analyze your billing process to track and monitor the most common reasons for claim rejections. If there is a sudden uptick in denials and rejections, you should set aside the effort to survey your billing process .

You may find that most of the claim denials are originating from one specific insurer or a specific diagnosis code prompts more rejections. Revealing the top reasons behind denials can help you rapidly improve the clean claims rate. A minor change in insurer’s prerequisites could be liable to an increased rejected claims. Let us talk about how to submit clean claims to reduce denials rate & claim rejections through proper denial management.

Ensure Insurance Coverage and Eligibility

Before providing service, the front office commits to check insurance coverage and benefits eligibility. After completing the verification, the clean claim is submitted to the payers, this process reduces the chances of denials In specific cases, it might be obligatory to get a referral or authorization number as these claims may get denied without a substantial one. Authorization regularly is dynamic over a particular date and may get terminated if not utilized during that time. A few authorizations cover a timeframe as well as a predetermined number of treatments or visits.

Nonetheless, note that getting earlier approval is as yet not an assurance of payment. The submitted claim must satisfy the accompanying conditions:

• It must be upheld by medical necessity

• It should be filed by the provider mentioned in the referral

• It should be filed within timely filing prerequisites

Use AI to Manage Denials

Applying creative trend-setting innovation empowers providers to build revenue productivity and accuracy. AI directs investigation to recognize the root cause and ensure error-free claims from the front end to avoid denials. You can track, measure and report on trends by physicians and payers. This information will assist you to analyze denial trends, figure out what assets are expected to execute solutions and track & report progress.

Stay Current with Payer Requirements

Medical billing rules and guidelines are continually changing, requiring doctors and administrators to invest time and cash on proceeding with instruction, directly affecting the income and benefits of the practice. There are a few codes that are stopped every year, there are a few different codes which are acquainted every year with reflecting regularly performed methods. Our medical billing company stays on top with current rules and regulations.

Outsourcing is the Best Choice

For healthy cash flow, you have to outsource your medical billing to a medical billing company that has an effective denial management team. We use effective strategies to handle your denials such as,

• To increase the success rate of appeal, we use a standard appeal template with approved standard verbiage.

• Prioritizing denials during the insurance follow up and denials will be worked within 48 hours.

• A Few out of every odd denial should be appealed. A few denials require dispute/appeal with the payer. For that, we defined the dispute strategy clearly; what is worthy of dispute & acceptable.

About MGSI

MGSI offers proficient medical billing and coding service to ensure your practice revenue cycle efficiency. We will assist you to resolve issues with denials and rejections. Become a partner with us and learn how we enable your practice to oversee claim denials. To know more about our services: visit us at www.mgsionline.com