How to Reduce Denials

May 6, 2010

What is the simplest method for reducing denials? Get the correct patient data from the start.

What is the simplest method for reducing denials? Get the correct patient data from the start. That means being proactive: You should start the data-collection process before the patient presents at your office.

If you are scanning patients’ insurance cards when they arrive for their appointment, it is actually too late in the billing cycle. This means your intake process is slowed down while your front-desk staff log onto a payer Web site or get on the telephone to verify the patient’s insurance coverage.

Start the registration process off right by capturing all patient information accurately and timely:

As soon as a patient calls for an appointment, collect her insurance information over the phone. Even better, promote your interactive Web site and let her do the initial data entry.

Perform insurance-eligibility verification two days before your patient’s scheduled appointment. Automate this process through your clearinghouse or revenue cycle management service so that your staff are not logging onto multiple payer Web sites to manually enter each patient member number. If you find that a patient isn’t eligible or your services are not covered by his plan, you have a day to contact him, and even fill that appointment slot if he cancels.

Use a kiosk solution in your office for same-day appointments or patient add-ons. The patient swipes his credit card (transmitting patient identifying data) in the kiosk and an inquiry is sent to the insurance company with the result transferred back to your staff regarding eligibility. Dr. Robert Kaufmann, of the Kaufmann Clinic in Atlanta, said, “The biggest benefit of the kiosks is the ability to verify benefits and decrease denials.” His clinic experienced a 90 percent decrease in claims denials after they implemented patient kiosks.

Don’t wait even a day to process a claim for the services you provide. Finalize the patient encounter at your check-out station. Staffers can utilize payer Web sites for real-time claims adjudication. Payers such as Humana, UnitedHealthcare, and the Blues (in several states) have been offering real-time claims adjudication for quite some time. Check with your revenue cycle management company to learn which additional payers can process claims in real time in your market.

With real-time claims adjudication, you’ll know the payer’s allowable charge and patient responsibility before the patient leaves your office. With this information, you will have the opportunity to ask the patient for full payment at the time of service.

Don’t wait even a day to register a patient or to submit a claim. Real-time registration, real-time eligibility verification, and real-time claims processing can eliminate denials from your practice!

 Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.