Solving Your Claims Processing Problems (Claim Denials)
With the ICD-10 billing codes set to replace the old ICD-9 system on Oct. 1, now may be the best time ever to take a closer look at your offices’ billing procedures and discover ways to improve your practices’ billing efficiency. Your AR department will soon be busy catching up to all the new codes and regulations, so, why not make the job easier for them, and more profitable for you, by implementing a few of these strategies designed to maximize the efficiency of your billing department.
Where to start?
To begin you will need to gather a bit of information on your own in order to evaluate the efficiency of your system. Whether you have your own in-house AR department, or are outsourcing your claims billing to an outside agency, you should have some idea of what percentage of the claims filed on your behave in the last 30 days have been delayed, denied on first submission, and the reasons given by the paying party for payment refusal. With this information you should be able to identify any shortcomings in your claims processing procedures.
Having acquired this information you should now be able to begin narrowing down the specific reason why these claims were initially denied, and make the proper changes to avoid repeat occurrences. A few of the primary causes, and best solutions for a claim denial that you may encounter are as follows:
Claims being filed with incorrect insurers – Make sure the patient information you have on file is current. Make it an office policy to copy patient insurance cards for your records upon each visit. Don’t forget to include any secondary insurance policies.
Claims denied due to incorrect, or erroneous information – Before filing a claim it should be examined carefully to ensure that all of the information supplied is accurate, up to date, and complete. This is where you should be especially diligent when it comes to the new ICD-10 codes. With the addition of over 50K new codes extra special attention may be required to ensure the claim is represented accurately.
Avoid duplicate claims – Minimum-billing cycles will go a long way to help in avoiding this time wasting error. Thirty days is a reasonable amount of time to allow the original claim to go through the payers processing system. You should also try to avoid automatically re-billing outstanding claims. Avoid cluttering up payment systems by contacting the insurer directly to collect information on why the claim as denied.
Of course, these are only a few suggestions that you can implement now to help streamline your claims filing system, and optimize your AR departments process’. The goal of course is to minimize denied claims that must be refilled due to avoidable human mistakes.