How to Prevent Medical Billing Claim Denials? - PowerPoint PPT Presentation

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How to Prevent Medical Billing Claim Denials?

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Title: How to Prevent Medical Billing Claim Denials?


1
How to Prevent Medical Billing Claim Denials?
  • www.mgsionline.com

2
  • While ensuring efficient patient care, Providers
    and healthcare practices work 24/7 to improve
    their billing performance and revenue.
  • However, the introduction of new medical reforms
    in the US healthcare industry have complicated
    their goals.
  • New coding techniques and insufficient training
    contributed to more claim denials.
  • It is estimated by the Medical Group Management
    Association (MGMA) that even the exceptionally
    performing medical practices end up with 4 claim
    denials.
  • Then imagine the claim denial rate of developing
    healthcare practices.
  • It is also estimated that almost 65 of claim
    denials are never corrected and refiled.
  • Even if healthcare practices take initiative and
    correct the denied claims, they dont submit
    before the time frame of 90 days.
  • All these factors affected many healthcare
    practices revenue cycle badly.
  • In this article lets see how we can prevent
    medical billing claim denials and improve cash
    flow through efficient denial management

3
Analyze and Determine the Cause
  • Avoiding claim denials involves a series of steps
    and the first one is to analyze and determine
    what causes claim denials in the first place.
  • Right from the frond-end to back-end services,
    there are several operations, which if not
    carried out properly can resort to claim denials.
    They are as follows,

4
01
Patient Registration
  • This is the very first step when a patient visits
    a healthcare practice and if it is not shown
    proper care, then there can be a huge amount of
    claim denials.
  • Front-office staff should make sure that they
    register the patient details accurately while
    verifying their insurance benefits and
    eligibility.

5
02
Coding
  • Accuracy in diagnosis and procedure codes is
    crucial to proper denial management. Carrying out
    the wrong diagnosis or coding incorrectly can
    result in a lot of claim denials.
  • It is for this purpose that healthcare practices
    should offer enough training to their staff to
    carry out unsurpassed medical billing functions
    as per the new coding techniques.

6
03
Billing
  • Sometimes, staff submit duplicate claims meaning
    they file a claim for a service more than once.
  • Such internal mistakes are perfectly avoidable
    and the denial management team should check twice
    before the claims are filed.

7
04
Filing
  • Claims have a certain time limit before which
    they have to be filed.
  • The time limit varies from payer to payer.
  • Insurance companies will deny the claims simply
    if they are filed beyond this time limit.

8
05
Payer
  • After analyzing all the factors, if there are no
    mistakes from the Providers end, then the denial
    management team must look into the Payer.
  • Sometimes, payers make errors while processing
    the claims.
  • If so, then call the respective insurance company
    and address the issue.

9
06
Prioritize
  • Once Providers fix the root cause of their claim
    denials, they should set up a good denial
    management team.
  • The team will further analyze which factors cause
    the highest impact and prioritize.
  • The causes are then eradicated one by one in the
    order of the prioritization

10
07
Claims Management Software
  • Yet another important step in managing claim
    denials is setting up a proper claims management
    software in to your system.
  • The denial management team should use data
    analytics and study the pattern of claim denials
    to optimize the software and offer great
    solutions.
  • This enables healthcare practices avoid claim
    denials in the future.

11
About MGSI
  • All the aforementioned steps can be done
    proficiently by a reputed medical billing
    company. 
  • Therefore, partnering with one will save ample
    costs for healthcare practices.
  • If you are looking for a highly-experienced
    organization then look no further than MGSI, a
    one-stop-shop to all your medical billing needs.
  • This Florida-based company has more than 20 years
    of experience providing exceptional denial
    management services to its clients.
  • To learn more details, log on to www.mgsionline.co
    m.

12
Thanks!
  • Does anyone any questions?
  • Mail us info_at_mgsionline.com
  • Call us 1 813 666 0028
  • Website www.mgsionlne.com
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