Common Causes of Claim Denials and Delays

Claim delays and denials have become more common these days, and these not only affect your cash flow and revenue but also damage your relationship with your patients. Although some denied claims can be appealed, yet even after a successful appeal, these claims get delayed or temporarily stay up in the air, which most patients, as well as practices, try to avoid! This can be avoided by outsourcing medical billing and medical transcription services from medical billing companies, like UControl billing. 

Other than that, knowing what the most common reasons for claim delays and denials are can help in their prevention. Some medical billing companies, as well as the insurers that your practice partners up with, may provide software tools that can help to prevent claim denials and claim rejections. It should be known that the claims that aren’t processed due to clerical errors are called rejected claims, whereas the claims that are considered but the payment is denied are called denied claims. In this article, we have mentioned a few common reasons that cause claim delays and denials. Keep on reading to know about them in order to prevent them! 

Reasons for Claim Denials

Incomplete or wrong information

The cause of denied claims can come from the beginning, i.e., as soon as the patient enters and register themselves. Therefore, the process of registration is important because if a practice fails to verify a patient’s insurance and other important information, then they end up transferring wrong or incomplete filled-up claims. Such claims will obviously get denied. 

This is the reason that you have a well-trained staff when it comes to the process of registration. This is very important as the staff of your practice has to ensure that all patient-related information is filled up correctly and completely. To avoid such blunders, you should provide your front desk staff with a list of the most common missed fields, like subscriber numbers or some dates. Ensure that every claim is double-checked before it is sent; you can also hire the best medical billing company that can double-check these for you! 

Failing To Obtain Pre-Certification or Authorization 

If your practice avoids getting pre-authorization or precertification that is required by an insurer, then it is going to cost you and your patient. This will result in decreased patient satisfaction. Therefore it is important that you know about the requirements of your insurers when it comes to pre-authorization. If your practice outsources from a medical billing company, then they will assist you by flagging the particular insurers in order to highlight what should be done. As the name suggests, the pre-authorization should be done before the procedure rather than after it is done.  

Claim Filed After Insurer’s Deadline

Setting the deadlines for claim submission varies according to the insurers, as every insurer has different policies when it comes to after-effects or results of missing a deadline. Some lenient insurers clear your process with just a phone call; on the other hand, some insurers demand detailed paperwork. 

Outsourcing Medical billing and medical transcription services from a third party will benefit you in this rangers as well. This is because medical billing solutions often notify about the upcoming deadlines for claim submission and also provide with the procedure that should be followed if a deadline is missed. However, in order to keep your revenue cycle from slowing down, it is better to submit claims as soon as your practice provides a service! 

CPT Or HCPCS Coding Errors 

Mistakes and errors in medical billing and coding still remain the most common reasons for denials. This is why a medical practice should make a habit of verifying as well as reviewing medical billing claims before they are submitted. The minute or two that your staff will take to recheck will save you from the claims delays and claim denials that will then require the tedious task of appealing. The process of appealing may stretch to weeks. To avoid such things, you can outsource coding services from UControl billing. The expert coders of this medical billing company will take care of each and everything for you! 

Use Of Out-of-Network Provider

Patients’ insurance providers may change from year to year. And sometimes, the patients themselves do not realize this. It should be kept in mind that if the insurance company changes, this may also change the medical providers that the patients can see in order to get full benefits under that insurance. This is the reason that before providing a medical service to a patient, their insurer’s information should be gathered in order to determine whether your practice belongs to the patient’s insurer network or not. By doing so, you can save your practice as well as your patient from any kind of misunderstanding. Here again, outsourcing from a medical billing company can save you from this too! 

Poor Coordination Among Staff

Too many chefs in the kitchen are the proverb that means that having excess men doing a single task means blunders! The same is the case in the submission of claims. If more staff is involved in the revenue cycle of your practice can lead to miscommunication as well as assumptions that the requirements are fulfilled by one another. This may create a loophole that will cause delayed or denied claims. If you do in-house billing, ensure that everybody is informed about their role and duties; otherwise, opting for medical billing services from a good medical billing company can help you to avoid this situation! 

Insufficient Medical Necessity

There are many instances where an insurer denies paying for a procedure that they consider to be medically unnecessary. This is a situation that is difficult for all the parties involved. In any case, the situation in which medical necessity isn’t clear-cut may be avoided by good communications and relations among the patient, clinicians, medical billing staff, insurers, and patients. This communication should happen before the procedure so that everyone makes informed decisions. Avoiding such a situation is better because when this happens, in many cases, the medical practice has to bear all the expenses, or the patient has to pay the full bill, and both these options are not great! 

Tips to Avoid Claim Denials and Delays

Delayed, denied, and rejected claims are very common among all healthcare organizations, and these situations can easily be avoided. It should be known that clean claims that are without errors and mistakes are paid quickly! Here are a few tips that will help your practice to reduce denial rates from front to back. 

Accurately register patients’ demographics.

Verify the insurance eligibility of the patient in advance. 

Get pre-authorization and ensure that it is inclusive.

Ensure that all claims are filed with the insurer in a time. 

Wrap-up! 

Most practices avoid claim denials and delays by outsourcing medical billing services from a medical billing company like Ucontrol Billing. Such companies have well-trained as well as experienced billers and coders who avoid the common causes and errors that result in claim denials and delays. This is the reason that such companies are in demand and also have high ratings! If you are looking for outsourcing medical billing or medical transcriptions services, make sure that you visit UControl Billing today!

 

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