by Ranadene Tapio, MBA, CMRS, CMC
January 24th, 2018
Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down. According to the American Academy of Family Physicians (AAFP), the average denial rate is between 5-10 percent. The result is the delay or cancellation of new practice initiatives that can aid in growth and improvement in patient care.
Here are four tips to help your practice reduce claim denials and maximize your reimbursements.
1. Investigate the root-cause
Correcting and re-submitting denied claims can be a monotonous and redundant task. But, the most important piece of the denial process is learning from the claims. Why are they being denied? In what part of the process is the mistake being made? Is it a staff, technology or automation issue? Identify the trends in denials and work to correct them. For instance, if your denied claims continually have errors in demographic information, you may consider addressing or re-training your registration team. If the procedure codes are continually wrong, you may have an issue with your coding team. When these gaps have been identified, lowering the denial rate will be easier and more effective.
2. Be prompt and persistent
Make it part of your process to review denied claims within 72 hours and respond and re-file within 5 business days. The time in between should be spent investigating, making a plan and gathering the necessary resources to re-file an accurate claim that will get adjudicated appropriately. In addition, don’t assume that just because a claim is denied that it is erroneous. Be persistent. Payers have a financial incentive to deny claims and sometimes do so with the most minimal issues. Reviewing and responding in a timely and persistent manner can help drop your overall denial rates.
3. Rely on industry experts
When possible, assign your coders to certain payers or specific treatment specialties within your practice. For instance, in a family practice, consider assigning a coder to women’s health and another coder to pediatric treatment. Having your coders separated like this can help them become experts in a specialized area of diagnosis and treatment. If assigning coders to different treatment areas isn’t possible, consider assigning your team based on payers. When billers are able to focus on and build a relationship with the payers, they can learn the intricacies of how, when and why they pay. They’re then able to submit claims that are less likely to be denied. With so many codes in ICD-10, it’s impossible for coders to know them all. Train and educate your staff or work with an outsourced provider on your coding efforts.
4. Automate, automate, automate
Implementing automation and technology can be daunting, but the benefits can be so much greater than the required effort. Your practice management or EHR system likely has modules in place that help optimize and automate pieces of the claims process. By implementing business rules, your practice can automate some of the mundane tasks currently carried out by your staff. What’s more, automating these tasks can improve the accuracy of your claims, thus reducing denials. It’s important to understand the capabilities of your practice management system. Work with your practice management consultant to create and implement business rules that can save your business time and reduce denials. These are just a few tips that will help your practice reduce your denials. Denials are just one piece of the overall revenue cycle management process. Best practices need to be employed throughout the entire process for maximized reimbursements.
Aim to be a practice with below average claim denials and above average patient care.
Ranadene Tapio MBA, CMRS, CMC, is the president of MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. She holds an MBA in Healthcare Administration & Management and multiple professional certifications. To find out more about the services her company offers, please email Randi@MedCycleSolutions.com or call 320-290-6448.