When it comes to active healthcare claims processing, it is essential to create a process that maximizes efficiency to handle denied claims. Most medical practice administrators get worried when it comes to working claims, particularly when the claims are denied. It is essential to identify the potential income loss and begin an effective medical claims management process for handling these claims.

The good news is that every small improvement will make a significant impact on the cash flow of your practices revenue cycle. Here are some tips on how to accurately process denied claims and increase the overall performance of your revenue generation.

Track All your Claims

This may seem like basic advice, but the fact is that many healthcare providers do not track all their claims. The only way to define the problem is to use an effective method that will help teams keep track of denials so that they do not lose a single claim.

Complete Your Denials in a Week

If a claim was submitted incorrectly it will get returned or denied, then it needs to be corrected and promptly submitted again. Many health insurance companies place time limits to re-file their denied claims. By making denials a high priority and actively addressing them quickly you can ensure that they are not ignored or lost.

Identify the Problem Within Your Claims Denials

Monthly, you should look over all the denials and try to locate any trends that might be a cause for errors on a large scale (global errors). By identifying a specific issue that several denials have in common, the problem can lead you to take practical steps to rework the claims and to avoid future denials. This can protect your Time, Money and Effort.

What happens if you find out an excessive number of mistakes are being made? Do you take the time to re-educate your staff, or do you choose to outsource?

Check out our blog on how to combat claim denials.

Outsource your denial management process

A good solution will be outsourcing your denial management process to an expert company that focuses on Revenue Cycle Management solutions. When you outsource medical billing, you are handing over your revenue cycle management to individuals with extensive training. If you have a cavity, you go to the dentist. Similarly, if you have trouble with your medical revenue cycle, you outsource medical billing.

When choosing an outsourced healthcare solution to use, there are a few questions you should ask like,

• Do they use expert teams that are highly skilled in working with insurance systems?
• What are their turnaround times to get the denials addressed?

By outsourcing your denial management process to a medical billing company, you will have more time to focus your attention on patient needs. Interested in learning more? Check out this overview of MEREM Health’s medical billing services.

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Incorrect coding, or miscoding, is likely for any medical practice that does not implement ongoing CPT code training for their medical coders. It is important to understand the consequences of these coding errors and it may be a wise investment to consider outsourcing medical coding to an experienced service provider.

Coding Errors Impact Patient Care

It is the foundation of every practice to provide quality patient care. Inaccurate medical coding can interrupt that goal, leading to frustration and confusion and a potential breakdown of the relationship you have built with valued patients. Even though the consequences of incorrect coding rarely falls onto a patient, it does happen, and it is the most important consequence to try to prevent.

Failure to code correctly could directly impact a patient’s treatment.

A great example of this would be using an incorrect diagnostic code. Codes have slight variances between the specificity of a diagnosis. Inaccurate coding of the specifics during diagnosis could result in improper patient care at another practice, or for a particular service. A missing 2-digit modifier for a knee injury could result in having an MRI study conducted on the wrong knee. Or, imagine an incorrect diagnosis code causing an obstetrician to withhold pains medicine during a woman’s pregnancy. This would be an extreme case, but altogether terrifying and harmful for the patient.

If circumstances similar to the examples above have occurred in your practice, it may be time to consider outsourced medical coding in order to improve the accuracy of codes and prevent these serious mistakes from affecting your patients.

Outsourcing also frees up a great deal of time, allowing practitioners more time with patients. (Did you know in-house medical coding costs more? Outsource!)

Coding Errors Delay or Prevent Reimbursement

Medical coding is the life-blood of a practice. That is how the services you provide are transformed into billable revenue. Failure to provide correct coding can cause these payments to be delayed, denied, or limited. MEREM Healthcare Solutions has found that an alarming majority of claims are rejected or denied upon initial submission. The reimbursement for denied claims depends on a practice’s efforts for correcting and resubmitting claim denials.

A miscoded procedure’s reimbursement has the potential to differ by up to $15,000. Delayed reimbursements are also costly, as they are unexpected. A build-up of delayed reimbursements can cause a backup of paperwork, stress on your staff, overlooked coding errors, and even more incorrect coding to be filed resulting in loss of revenue for your practice.

This back up of denials due to coding errors requires focused efforts to catch up on claim denial and improve your revenue cycle. The healthcare revenue cycle/reimbursement cycle is a very particular machine.  All aspects need to work together just right and at the right time or the system breaks down.

Coding Errors May Lead to Fraud and Abuse Fines

As you can see, incorrect coding causes poor patient care and trouble with reimbursements, but what happens to those responsible? Practices and providers who have a history of coding mistakes may face fines and or federal penalties for fraud or abuse.

The False Claims Act (FCA) is the enforcement tool used for false claims. The consequences could be a monetary penalty or a legal issue if the claim is named fraudulent. To prove fraud occurred rather than abuse, the upcoding or miscoding of an event must occur over time and across a large number of patients.

We recommend all practices be proactive in monitoring their claim denials by setting Industry Benchmark Goals for our clients and by offering a complete Revenue Cycle Audit.

Understanding the Outcome of Outsourced Medical Coding

Medical coding can be an excessive amount of work, and small errors can cause significant harm. When practices outsource their medical coding, fewer mistakes are made, better care is given to patients, and billing cycles run smoothly.

Are your ready to improve your revenue cycle while avoiding the consequences of coding errors? Contact MEREM Health today to discuss outsourcing your medical coding.

The post Consequences of Coding Errors appeared first on MEREM Health.

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.

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