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5 Ways to Prevent Claims From Being Denied and Improve Collections

December 11, 2019

Medical Claim DenialsGetting claims paid in a timely manner and as efficiently as possible is vital to the strength and longevity of your medical practice. According to some estimates, it costs medical providers an average of $6.50 to file each claim with an average of 5 to 10 percent of these being denied. When claims are re-submitted, the cost to do so jumps as high as $118. Up to 65 percent of denied claims are never even re-submitted at all. 

Most Denials Are Avoidable

Nearly 70 percent of claims that are denied are also appealable. Because about 90 percent of denied claims are also avoidable, honing in on preventing them in the first place can lower the overall costs for a medical practice and improve its revenue. Take the steps outlined below to help prevent avoidable claim denials. 

1. Keep Up With Changes

The medical industry is a constantly-changing entity, and that reality isn’t going away any time soon. Make sure that your staff stays updated on any and all regulation and rule changes by fostering an environment that emphasizes improvement and learning. 

2. Look At Past Denials

There’s a reason why your claims are being denied, and it likely lies within your own staff. Take the time to look internally and track down the cause of these past denials. Learn about how the mistakes occurred and which actions must be taken to address them in the future. 

3. Do Pre-Authorizations Right

By getting pre-authorization, your medical practice can experience fewer denied claims — as long as they are for the procedure scheduled. Prior to submitting the claim, ensure that every authorization is carefully documented and double check before going forward with the procedure. Be sure to fully document any changes and give everything a final once-over before submitting the claim. 

4. Emphasize Teamwork

Let’s face it: in many medical offices, it’s seems like the staff is divided into clinical and non-clinical sectors that almost seem like separate entities. The reality, though, is that everyone who works in your medical practice is part of the same team. 

Everyone needs to understand that denied claims affect the entire office. Even if they aren’t part of the billing department, each member of your staff should work diligently to ensure that the process is a streamlined one from start to finish.

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Understand that mistakes are going to happen. Rushing to blame people isn’t an effective method of prevention for the future. Instead, research to find the cause and ensure that the person responsible had the understanding they need to prevent similar mistakes on claims going forward. 

5. Make It Easy To Work Smarter

There’s a great deal of buzz regarding working smarter with it also encompassing many of the points noted above. In addition, implementing the following strategies can streamline the claims process so it takes up less time: 

  • Integrate Automation

Automation is here to stay and embracing it can help boost your practice’s revenues. This is especially true when it comes to submitting medical claims. The best software focuses automatically updating procedures and codes, includes project management tools and streamlines the processes required for both claims and billing. 

  • Meet Deadlines

It seems like meeting the deadlines for submitting a claim would be an easy task. If your billing department is overwhelmed by a mountain of claims that they must navigate using an aging system though, it could be your reality. 

  • Review Claims 

This should be the final step prior to submitting a claim. While it sounds like such a simple step, it often gets overlooked during the rush to tie everything up at the end of the day. This is where teamwork can help because it’s often easier for another person to spot a mistake than the one who made it initially. 

The takeaway from the above points rests with the claims system you put into place for your medical practice. M-Scribe Medical Billing specializes in helping your medical practice run more efficiently while also boosting your revenues. Learn more about how we can help by contacting us today at 770-666-0470 or email me at 


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