According to a recent report in Becker’s ASC Review, the healthcare economy is in the throes of claims denials. In reality, the solution to this rash of denials lies in leveraging the advantages of new robust revenue cycle management tools. Medical billing and coding companies and medical practices that use the latest technologies can manage denials more effectively and eliminate claim rejections.
There are many reasons why claims are denied:
- The procedure was not medically necessary
- Lack of sufficient documentation
- No prior authorization
- Medical service not covered by insurance plan
- Coding issues such as incorrect modifiers, invalid diagnosis codes, non-covered charges and bundling procedures together
In the current environment of increased payer scrutiny, managing claims denial requires a powerful approach. As the Becker’s ASC Review points out, leveraging the market’s latest technologies will invariably turn denials into manageable metrics. Leading medical billing companies do work with advanced technology to help physician practices code, submit and track claims and prevent denials. These top tools include the following:
Premium quality medical billing software can save time and money, increase practices’ reimbursement average, and decrease the volume of claim denials. Medical billing experts can work on any type of advanced software such as PracticeSuite, Advanced MD, NueMD, NextGen, Kareo, and more. They provide customized billing solutions for practices of all sizes, and leverage modern software to easily manage larger amounts of claims and patient loads.
Medical office platforms also include medical coding software. AAPC-certified coders in leading medical coding companies use technologically advanced systems that come with CPT, ICD-10-CM and HCPCS Level II online code look-up software. Such platforms offer speedy and detailed search capabilities of several volumes of procedure, service/supply, and diagnosis reference material and lay descriptions in real-time. Code updates prevents improper coding and allow billing Medicare Part B and private payers’ codes accurately throughout the year.
Experienced providers of medical billing service are also equipped to leverage the denial management workflow tools of medical clearinghouses and payer portals and websites. These tools enable practices to track and address claims efficiently. They allow mapping of denial codes, which helps manage denial trends proactively and also in developing quality reports, which can capture potential lost or delayed revenue. This helps the medical billing company take corrective action in a timely manner.
For medical practices, implementing these tools would require set-up time and training, as well as additional staff. Medical billing and coding outsourcing to a technologically advanced vendor is the best way to fine-tune the claims denial process, lower AR days and reduce denial write-offs.