Denial management is essential to improve your chiropractic practice’s revenue growth. Denial management involves assessing the root cause of denials and using a proactive approach to ensure proper submission. Some of the major reasons for chiropractic claim denials are – missing information on the claims, assigning the wrong codes, duplicate claims, service ineligible according to a healthcare plan, and missed deadlines.
By implementing actions such as pre-verifying insurance coverage, training your staff on proper coding, and appealing and following up on claim denials, practices can boost their cash flow for continued success. Incorporating denial management tactics can bring significant benefits to your chiropractic business, as it streamlines various areas of your practice. With more efficient claims processing, your staff can handle more tasks and free up time for other important responsibilities. Your practice can receive faster reimbursements with fewer denials. Having an organized and streamlined denial management process with the support of chiropractic medical billing companies is key to a healthy revenue cycle.
Effective Denial Management Strategies
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- Proper insurance verification
Proper insurance verification is essential before providing chiropractic treatments, to reduce claim denials. Verification ensures that all patient information is correct and up-to-date, and that the insurance coverage is valid. It can also help avoid billing errors that could lead to incorrect reimbursements or rejected claims. When a claim is denied, it can result in significant financial losses for both the patient and the healthcare provider. Insurance verification process involves confirming a patient’s insurance coverage, checking for any pre-authorization requirements, and identifying any exclusions or limitations in the policy. This information is essential to determine the patient’s out-of-pocket costs and the amount that the insurance provider will cover. Accurate verification can also help healthcare providers determine the most appropriate treatment plan for the patient, based on the insurance coverage available. It can also improve the patient experience.
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- Let patients understand the cost
Patients who are informed about their insurance coverage and out-of-pocket costs upfront are more likely to be satisfied with their care and less likely to be surprised by unexpected medical bills. To prevent claim denials, it’s more important than ever to have clear, direct communication with patients regarding their payment responsibility. This also helps healthcare providers improve patient satisfaction, reduce the risk of payment delays or denials, and ultimately improve the financial health of their practice. Staff should be available to answer any questions or concerns that patients may have regarding their bills and work with them to find solutions to any payment issues that may arise. Patients should also be informed about any payment options and timelines for payment.
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- Appeal Denied Claims
If a chiropractic claim is denied, consider appealing the decision. Also, train your staff to manage appeals. If an insurance carrier denies a claim, practices can request a provider inquiry as the first level of appeal, which must be done within 18 months of the provider’s original claim remittance. The denied Explanation of Benefits (EOB) and the payer’s policy should be reviewed before submitting the inquiry, as statutes may vary. Depending on the carrier, claims denial management may require completing forms supplied by the carrier and/or drafting an appeal letter with supporting documentation, such as exam findings, outcome assessments, and documentation notes.
An appeal letter should be submitted with all supporting documentation, including beneficiary name, membership number, date of birth, claim/reference number of the denied service, the amount billed, the reason for the denial, the reason for the appeal, and the signature of the appointed representative.
The appeal letter should be brief and it is best to avoid emotional statements or unnecessary information. Professional chiropractic billing companies will have experience with the right appealing process.
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- Do proper follow-ups
Following up on denied medical claims is essential for medical practices to ensure timely and accurate reimbursement for their services. It involves investigating the reasons for claim denials and taking appropriate actions to correct any errors or resubmit claims with additional documentation or clarification. Proper follow-up can help chiropractic offices identify the reasons for the denials and take corrective actions to ensure that they receive the payments they are entitled to. It also helps practices to reduce their administrative costs by streamlining their billing and claims processes. Practices can prevent future denials and reduce the need for additional administrative work. They can also ensure that patients are not left with unexpected bills and that their claims are processed in a timely manner. Practices can also comply with all regulations and avoid any penalties or fines for non-compliance.
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- Assign the right codes
Proper documentation of chiropractic conditions on the claims is necessary to maximize reimbursement. Improper coding can lead to costly claim denials and resubmissions. It is critical to train your staff with proper chiropractic coding training. Claims should include valid ICD-10, HCPCS and CPT codes that support the medical necessity of the service. Also, use modifiers correctly. Rely on medical coding services provided by skilled coders to ensure on-time reimbursement.
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- Submit claims on time
One of the most common reasons for a denial is a missed deadline. Timely submission of claims ensures that the payer has enough time to process the claim and make the payment. Different payers have different timelines for claim submission, so it is essential to know the specific timelines for each payer. To avoid denials due to late submission, make sure to submit claims as soon as possible after the date of service.
Proper denial management is vital to the success of your chiropractic practice. Don’t let claim denials impact your bottom line. Professional denial management experts will analyze the reasons for claim denial and take proactive steps to appeal denials, and implement proper claim submission processes to prevent further issues.
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Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.