Claim denial is a term that refers to the refusal of an insurance company or carrier to honor a request by an individual medical service provider to pay for the services provided to the patient.
This is one of the most extremely difficult challenge for hospital owners nowadays. Due to frequent changes in the federal and payer’s policies, hospitals are ending in a reported loss of net patient revenue ranging from 1 to 5% for their business or around two to three million dollars yearly for an average 300-bed hospital.
Although, with proper hospital billing services, practitioners can appeal these denied claims and rework on them to recover their denied claims. The hospital spends approximately $25 cost per claim just to get them paid completely. Unfortunately, due to the claim success rate for the appealed claim vary from 55% to 98% depending upon the capability of the management for the hospital billing.
In this article, I have mentioned 5 impactful solutions to streamline hospital billing services by resolving commonly occurring errors and maximize revenue.
1. Provide Complete Information Before Filing A Claim:
61% of initial denials in the hospital billing services
and 42% if denial write-offs occur due to the incorrect information and incorrect plan code while submitting a claim. Thus, it is very important for the billing team to perform due diligence while gathering information in order to file a claim. It means that verification of all the information is essential to fill the forms out properly.
Make sure that your team must have the required tools and equipment to do their tasks faster and more efficiently. With a proper medical billing solution, they can efficiently check the coding, bundling, and procedure information on the claims before submitting to the payers. In this way, the payers will receive accurate claims and they would find no reason to reject a claim due to the information mistakes.
2. Never Appeal Claims On The Same Date:
It is one of the biggest mistakes of a medical biller to send the claim on the same date to the same provider for the same beneficiary. Even this time, it has provided complete information for all entities, Medicare Part B will deny this kind of claim. Therefore, hospitals should avoid this by encouraging their medical billing staff to double-check if a claim has already been submitted before filing another one.
Motivate the team to choose user-friendly and efficient software solutions for hospital billing services. It would make it easier for them to track and check the status of all the claims.
3. Verify Insurance Eligibility Of The Patient:
If the front desk staff does not check the insurance eligibility details of the patients then they can also end up in claim denials. Thus, if they fail to notice updates in the payer’s policies then they end up filing claims that would not be covered by the payer.
Therefore, the front desk staff must regularly update the patient’s insurance eligibility criteria and also the basic profile of that patient in order to ensure that you have the most updated information.
4. Use Alarm System To Schedule The Claim Filing Process:
All of the insurance payers have their own limit to the number of days a medical claim can be submitted to a payer. Therefore, the team members that are working for hospital billing services must keep the track record of the schedule of each payer. They should know the grace period of each payer which also includes the time you will take to rework any rejections.
You can also implement an alarm system to incorporate into your workflow that will notify your medical billing staff that is approaching the deadline to submit a claim.
5. Use Accurate Medical Codes:
It is the most important aspect of the whole objective of hospital billing services. Medical billers should follow the current guidelines for medical coding in real-time to file their claims accurately. If a claim has accurate medical codes that are used at the highest level of specificity then they certainly get reimbursed. However, if a payer reviews a claim and finds an incorrect medical code then get denied or reduced by the payer. The incorrect choice of medical codes can lead to the following 2 situations;
Upcoding: If a medical bill is assigned to the more expensive medical procedure.
Under coding: If the medical biller doesn’t mention the information about the services provided by the hospital.
6. Medical Coding At The Highest level Of Specificity:
The best solution to prevent the errors occurring in the information is to use the highest level of specific codes. For this purpose, medical billers should acquire the comprehensive patient record. It includes the laterality, severity, and accompanying conditions of the service provided. It is a key tool to optimize hospital billing services and impacting the reimbursement models positively.
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