7 Common causes of denials and how to prevent them

There is no denying that claim denials can prove to be a major headache for medical practices. Denials not only have a negative impact on the cash flow but also affect practice efficiency. Wondering what is causing denials at your practice?

Here are 7 common causes that you should be aware of:

  1. Administrative mishaps are one of the most common reasons why denials happen. For instance, if your front-office staff has accidentally resubmitted a claim before giving the insurance company enough time to respond or if they have resubmitted the claim instead of following up on existing instance, then the claim will get denied. So it is necessary to have well-trained front-desk staff at your practice.
  2. Then inaccuracies in coding. If the coders aren’t trained to use ICD-10 codes, then denials can’t be avoided. This is why it is necessary to have coders who have a strong knowledge base of clinical coding. Also, latest practice management solutions will be needed if you want to avoid denials and collect more.
  3. Another common reason for denial is missing or incorrect patient information. If there are manual errors at the front-desk and the staff mentions incorrect data, then it can lead to denials. Therefore, front-desk staff needs to be given sufficient training to help them avoid such errors.
  4. If the documentation isn’t supporting the medical necessity, the payer will be unsure of the procedure and deny the claim. In such cases, your staff should be well-prepared to provide additional documentation to the payer that will support the level of service and determine medical necessity. If not provided, the claims won’t get paid.
  5. Timely claim submission is equally important if you want to avoid denials. Even if there are no errors in the claim but it is submitted late, it will result in denials. Therefore, make sure your billers are submitting claims within the claim-submittal period.
  6. It is necessary to ensure that the patient’s coverage hasn’t been terminated. Verification of insurance benefits needs to be done prior to services being rendered to the patients. This will alert your medical office about the status of the insurance coverage.
  7. If there is no co-ordination of benefits, then it will be a problem. Your staff needs to be aware of the guidelines for billing each health insurance plan.

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