5 tips to reduce denials and capture ‘lost' reimbursement

Why This Topic Matters

Denials and underpayments can materially affect practice revenue, and recurring patterns in remittance data may indicate process issues that need attention. The article helps readers understand the broad operational areas involved in managing Medicare claim performance.

Article Sections

1. Use billing software to scrub claims before submission

   Discusses automated claim-scrubbing and data validation in billing software, along with the role of keeping claim-edit logic current when payer rules change.

2. Review remittance notices for signs of underpayment

   Covers how remittance information can help practices notice possible fee schedule mismatches and reimbursement amounts that may be below expected levels.

3. Track denial codes to identify trends

   Explores using denial-code patterns to spot recurring billing, registration, duplicate-claim, and bundling issues within a practice.

4. Create a denial log or use a third-party biller

   Describes manual and outsourced approaches to reviewing denials, including internal auditing and trend analysis of claim batches.

5. Coordinate coding, registration, and payment posting workflows

   Addresses the need for communication between operational teams that enter data, process claims, and review remittance information.