4 Tips to Avoid Common Mistakes Resulting in Claim Denials

Successful claims are very critical as it’s the major source of revenue generation in the healthcare industry. Across the globe, teams working on claims spend a great deal of their time and hard work in making medical bills and submitting claims. But, all this labor just becomes waste if the provider denies the claim. Here, if the institution wants to submit cleaner claim, then a 360 degree approach should be adopted wherein all the claims that have been generated are scrutinized thoroughly before submission. These tips at the time of generating and submitting claims can be very useful in reducing the chances of claim denials and increase the revenue.

1. Inappropriate information:

Right from patients information to provider’s details everything is important and essential to avoid claim denials. Wrong or insufficient data can result in putting the whole revenue cycle management process at stake. This can be a minor error done by the billing team, but its outcomes can be severe, as it not only puts the patients and institution involved in financial stress but also tarnishes the image of the medical institution.

2. Special Attention to Codes:

Up-coding, un-bundling and mismatch in diagnostic and treatment codes are the common medical coding errors which occur due to inefficient resources and negligence of the administration. Hence, it is important to understand which code has to be used and where. But, this is not an easy task as it requires the resource to have full knowledge of ICD-10 coding and recent changes of the same. So, institutions should maintain frequent code updates and put maximum focus on coding at the time of generating claims, which surely mitigate the chances of mistakes which causes claim denials.

3. Transparency and Submission of Medical Records on Time:

Usage of Information Technology in healthcare is astounding but technology without human is nothing. That’s the reason, why efficient professionals are required to leverage maximum benefits of Information Technology. However, recruiting human resource who are talented and have the competency to handle the IT functions of the medical group is critical. Therefore, to save the efforts of recruitment and money spent on hiring, only that professionals should be hired who are extraordinary and have immense knowledge of the technology they will work on.

4. Eye on Frequent Modifications:

Rules governing medical billing and coding are in a constant state of motion. You can never know when and what changes may occur in them. Hence it is always advisable to be extra cautious and keep an eye on the updates — be it with regards to coverage, inclusion or exclusions of codes and many more — while generating claims.

So, it is evident now that small changes and course corrections while submitting claims will be very useful to avoid claim denials. Unfortunately, it can be a long drawn out procedure that can put a lot of stress on your resources. But, if you want to overcome all these troubles and see instantaneous results, than outsource denial management services to OutsourceRCM is the right answer. We are a premium denial management company with extensive experience in handling complete cycle of denial management with complete root cause analysis of the past rejections to reduce the chances of future errors completely.

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