Health insurance provides financial support to policyholders by covering certain medical expenses. Sometimes, a health claim gets rejected, even if it’s an insurance company your practice regularly works with. Dealing with rejected claims is time-consuming, annoying, and confusing. Keep reading to learn about ways to avoid rejection from contracted insurance companies!
What are Rejected Claims?
There are two ways a contracted insurance company may notify a practice that they refuse to pay. First, a claim rejection happens before the claim is processed by the insurance company. A rejected claim contains errors found before the claim was processed. This can be a coding error, information error, or policy error.
Insurance companies can also deny a medical billings claim. The formal definition of a medical billing denial is the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for healthcare. Some denials can be appealed by the submitting practice. The reasons for a denied claim are varied. The reasons for rejections and denials are very similar.
Most Common Reasons for Rejection and Denial
One of the most common reasons for rejection is missing information. Leaving just one field blank on a required form can trigger a rejection. Many initial medical billing rejections deal with demographic or technical errors. It is important to ensure that patients fill out all required forms before the start of their visit. Pre-checking a patient’s insurance before their visit can also cut down on the number of rejections related to incorrect policy numbers or eligibility.
Another common reason for rejection is incorrect information. Using outdated or incorrect diagnoses and service codes can lead to rejection and denial. Additionally, using the wrong format for a policy ID or group number will cause a rejection. There are many other reasons a claim may be rejected, such as duplicate claims, services, and eligibility. Though rejection and denial are common, your practice can prevent them from occurring in many ways.
How to Avoid Rejection from Contracted Insurance Companies
Rejected claims cause a decrease in productivity and can have a serious negative effect on your bottom line. The good news is that 90% of denied and rejected claims are preventable. Here are some ways you can improve your practice’s rate of rejection!
Verify Insurance and Eligibility
Early verification of insurance may seem obvious, but its importance cannot be overstated. Never assume a long-time patient has not experienced an insurance carrier or policy change. Collect patient insurance information when they make their appointment and verify it. Make note of services that are not covered and communicate that information to the patient and the provider.
Collect Accurate Patient Information
Documentation is essential in the medical billing cycle. Missing or inaccurate information is one of the most common reasons for medical billing claims rejection. Some of the most commonly missed data points are the date of the accident, the date of the medical emergency, and the date of onset. Institute a standardized check-in process at the front desk where patients fill out and sign all the required forms. During their appointment, double-check that every field on each form is completed.
Analyze and Update the Process In-house
Keep a record of rejections and denials and how they were solved. Look for patterns in rejections to uncover weak links. Use this information to develop new processes to strengthen your practice’s operations.
Outsource Your Medical Billing and Coding
Outsourcing your billing and coding can be a huge time-saver and help you avoid costly mistakes that lead to claim rejection. If you’re looking for a medical billing company that can help you streamline your process, reach out to Medbillytics. Medbillytics has the experience and expertise necessary to help you streamline your billing process and improve your bottom line. Reach out today to learn more about how we can help you!
How Can Medbillytics Help You?
You may have been recommended to us by one of our many satisfied customers, or you may have searched online for “medical billing services near me.” However you found us, we’re happy to welcome you. Let Medbillytics help with your healthcare practice’s credibility and reputation. Reach out to learn more about all our services today!