Four Areas to Review to Reduce Denied Medical Claims

August 24, 2013

There are at least four areas to review on a monthly basis to reduce denials at your medical practice.

Tracking your practice's denials is a fantastic idea. It helps you identify where your mistakes are occurring, so that you can update your internal policies and procedures accordingly. But, more importantly, there are several other areas that you can track to ensure that your denials continue to decrease. This shows that you are managing this area of your practice effectively.

There are at least four areas that you can review on a monthly basis that will ensure your denials will continue to decrease, they are:

1. Your charges out, your payments in, your adjustments and your percent collections.

It's not just the charges out and payments in. If your billing staff is making decisions to write off accounts without your knowledge, your adjustments percent will be higher than contractually necessary. Track this on a monthly basis and see how this will change.

2. Your billing register should tell you lots of information about your billing department. You will have your monthly charges, and the amount you actually billed out. The difference will be the number of re-bills completed. Your billing department rebills a claim when a correction has been made. A correction is driven from a denial. The number of rebills is a direct correlation to the number of denials.

You'll take the dollars billed out minus your monthly charges, and get your dollars rebilled.

3. Your paper denials are the next area to review. Conduct a physical count each month on how many of these paper denials come into your practice. This is complete transparency of your billing department.

Contractual adjustments are not denials, but if a therapist cannot code correctly, this is an area to review.

4.Electronic Explanation of Benefits (E-EOBs) is the next area. These are very similar in context to the paper denials, the E-EOBs reveal a lot of information that can help you review your systems and processes.

E-EOBs can be easily tracked by your billing department. An accurate hand count should be completed monthly.

The key to reviewing all of this information is to utilize the results in an effective manner. If you find that you are seeing a workers' compensation patient that has an out-of-state plan, they may not use the workers' compensation codes for your state. The best thing to do is to call the nurse-case manager and ask! Don't just write those off as un-collectable. Make a five-minute phone call and find out.

If you are managing an insurance contract that places a monetary cap on how much a patient can use for their medical treatment, adhere to that cap. When you exceed it, it is much less likely that you will be able to recover those claims. If there is any other visit limit, or number of times you can code a procedure within a year's time, find out when the front office performs the insurance verification.

There is a reason why insurance companies dominate the healthcare market, and small practices are going out of business. They bank on the fact you won't follow up. Make this a priority of yours, today.