decisionhealth Newsletters, Part B News - 2003 Issue 10 (October)
Try these 3 strategies to reduce denials - and get paid the first time
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Article Overview
This article describes three general denial-reduction strategies used in physician practices and medical imaging groups: proofreading and pre-audits, a pre-billing review process, and software scrub tools. It is aimed at billing, coding, and practice management staff who want to understand common front-end workflow approaches for cleaner claims and fewer avoidable denials. The discussion stays at a practical process level and references broad coding and payer-related checks without serving as a coding reference.
Why This Topic Matters
Avoidable denials increase rework, delay payment, and can raise administrative costs. Understanding common claim-preparation workflows helps practices evaluate whether they need stronger pre-submission review processes or software support.
Article Sections
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Proofreading and pre-audits
This section describes a claim review step performed before filing and discusses how practices use it to catch data issues and other preventable problems. It also references a sample Medicare-related scenario and the role of modifier handling in that workflow.
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Pre-billing department
This section explains the use of a dedicated pre-billing review function and the kinds of operational planning that support it. It focuses on staffing, data verification, and preparation for implementation.
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Software scrubs
This section covers claim-scrubbing software and the types of edits it can flag before claims are sent. It also discusses how practices use reports and payer-specific tailoring to support front-end claim correction.
What You Will Learn
- How practices structure front-end claim review to reduce avoidable denials
- What kinds of workflow steps are used before claims are submitted
- How software-based claim edits support billing and coding operations
- Why payer and data verification processes can affect reimbursement timing
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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