Step by Step Efforts to Combat Claim Denial

A practice’s efforts to reduce claim denials should begin with an understanding of its greatest source of denials.

Run a series of denial reports over a period of time (3 weeks, or 3 months) that include:

• denial reasons
• procedure codes reported
• modifiers
• diagnosis codes
• payors

The results can be your greatest asset in identifying the source of denials. You can then sort the reports from each field to determine a particular coding issue and identify the greatest opportunity for your practice to focus on denials improvement.

Pay Attention to Timing

Although often unintentional, timely filing is a leading reason for denied claims. Each payor has their own filing deadlines that range from 90 days to 1 year. Failing to submit a claim within their assigned period will result in rejections that your practice may have to write off.

Even if denials have been reworked and claims adjustments have been resubmitted, the corrected claims must meet the original filing deadlines in order to be approved.

Poor management of claims can be detrimental to the financial health of a practice. Avoiding claims denials should be the responsibility of everyone in the practice. For more information about how MEREM Healthcare Solutions can help you combat claim denials, follow us on LinkedIn and check out future a continuation of this blog in the coming weeks.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.
We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.