Skip to main content

Common Medical Billing Denials and How to Avoid Them -Avontix

A medical billing denial occurs when the insurance company refuses to honor the request to pay for the healthcare services provided by a healthcare professional. Medical billing denial is a serious matter as it has a negative impact on the healthcare provider’s cash flow, revenue cycle and operational efficiency. The rate of medical billing denials is usually between 5% and 10%. If you are the best in medical billing jobs, then this rate is around 4%. Medical billing denials can always be avoided and reduced with care and a reduction in medical billing denials improves the revenue cycle of the healthcare facility. To avoid denials, you should first understand the common medical billing denials and then you can take remedial action for the denials.

Common medical billing denials:

  • Information is missing:  Any information that is missing, any code that is missing or incorrect code, any wrong information or missing information regarding the social security number may lead to the claim denial. These kinds of denials account for more than 60% denials.
  • Duplicate claim:  Claims that are submitted again for the same service provided on the same date by the same provider and for the same patient are duplicate claims.
  • Adjudicated services: Denials may happen when benefits for a service are already included in the payment for another service that has been settled.
  • Charges not covered: The services that are charged in the claim may not be covered by the insurer under the benefit plan.
  • Filing limits: Most insurance payers have directives that the claims are to be submitted within a time frame for the services provided. If this time limit is not met and claims are submitted beyond the specified time, then the claim may be denied. People in medical billing jobs should have alerts in place to avoid filing claims beyond the time limit.
Though denied claims can be worked upon later, avoiding denials should be the priority for healthy revenue cycle of the healthcare provider. Let us see how we can prevent medical billing claims.

  • Categorize denials: You should be able to quantify and categorize the denials by tracking them on the basis of doctor, specialty, treatment and insurance payer. For this, you can rely on technology and data analytics and they prove to be worthy of time and money invested.
  • Create team: Create a team that is responsible to analyze denials and identify what kinds of resources are required to get solutions.
  • Improve data quality: All the healthcare facility staff that deal with patient data must ensure that the services being provided to the patient are covered by the patient insurance. The staff should also be cautious while recording patient details as any small error in these details may lead to denials that cause a lot of time and money waste.
  • Check coding processes: If the denials are arising as a result of insufficient medical necessity, you should check where the problem is and bring in necessary processes to prevent such denials.
  • Don’t neglect pre-authorization: Neglecting to perform pre-authorization processes may affect your revenue cycle very badly. It is always better to get pre-authorization for a treatment or procedure rather than getting it authorized after performing the procedure.
  • Never miss deadlines: It should be your priority to submit claims and follow up on these claims within the stipulated deadlines.
For a great exposure in the field of medical billing in Hyderabad, join the Avontix team, which is into the business of medical transcription and medical coding also. Avontix is one of the top medical billing companies in Hyderabad.

 Visit: Avontix

Post a Comment

Popular posts from this blog

That’s Hilarious! Funny Must-Read Medical Transcription Errors!

Doctors every now and then come across some very critical bloopers from medical transcriptionists. Some of these can be downright funny! It’s common for transcription errors to creep in for various reasons like the dictation might not be clear, too many medical terms stuffed in, or misunderstanding at the transcriptionist’s end. Medical transcriptionists vary in experience and skill and may not be well versed with some medical terms. Here is a compilation of some very funny transcription mistakes you could note to avoid being on the receiving end of the laughter! 

   ·"Eyes and nose continue to be within normal limits" (I & O).    ·"History of sick as hell disease" (sickle cell)    ·"She was a bitch and grinned" (a bit chagrined).    ·"The last day the patient took their meds was for beaver."  (forever).    ·“49 year old occasional male”(Caucasian male).    ·“Borderline respectable pancreatic cancer”. (Resectable).    ·“Patient is alert and orien…

Working in the night shift? Here's how you can be double productive! -Avontix

Waking up and stretching at 4 PM. Having breakfast around 6 PM, rushing to office at 8 PM, when others are having a cozy dinner with family. Is this you?
Although there will be initial hiccups in adjusting to the night world, with time we understand that night shift work can be as smooth as day shift, provided we take care of few things.
Train your mind: The first and foremost feeling that we have to inculcate in us is that we are not doing anything different from routine. We ought to get used to and train our mind that night shift life is similar to that of the day shift life. With this. it gets much simpler for us to get accustomed to the new lifestyle. Winning our mind is winning half the battle.
Eat healthy: Work schedule affects our eating habits and vice versa. With sudden changes in work timings, our eating pattern gets disturbed and this results in health disorders which in turn reduce our productivity.
Pack home food:  Be a little stringent with yourselves and pack home cooked …

Location isn’t a Matter for Coding and RCM -Avontix

The technological developments in the healthcare management industry have facilitated and increased the outsourcing of medical coding and RCM among many healthcare facilities. The healthcare facilities need not bother about from where the support for their RCM and medical coding jobs is coming from. What they need to think about is only if these service providers have the latest technology, training and subject expertise. These days most of the outsourcing companies are well equipped with high-speed internet connectivity, coding and RCM software with security features that make the importance of the location of the service provider negligible.
The lower reimbursement rates and diminishing margins are forcing the different healthcare facilities to think for ways to reduce costs. One of the best ways for hospitals and other facilities to minimize costs is outsourcing their medical coding jobs along with their revenue cycle management. The significant task for a hospital is to identify …