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How Best to Handle Denied Medical Billing Claims

November 18, 2014

Denial_managementKnowing how to best handle a denied claim is essential for correcting a situation and figuring out how to obtain the payment anyway. Unfortunately, denials management is a neglected area of the industry. Most people avoid it because it requires such specialized knowledge of the procedures as well as some intensive labor of talking to different people and filling out numerous forms.

How to Handle Denied Claims

First and foremost, handling a denied claim requires a team of people assigned to post and follow-up on the denial. Having a team handle the situation usually results in better identifying and addressing payer reimbursement issues. 

This being said, you need to do three main things to handle denied claims effectively:

  1. Count how many denied claims there are.
  2. Identify the cause of each denial.
  3. Create a tracking/reporting process to measure your performance throughout a period of time.

Why Denied Claims Occur

Two of the most popular reasons for denied claims are registration issues including insurance verification, patient information, and payer information and charge entry validation including invalid procedures or diagnosis codes. Some other common reasons for denied claims are referral and pre-authorization issues, invalid patient information, duplicate information, failure to meet medical necessity requirements, missing documentation, bundled or non-covered issues, failure to meet credentialing requirements, and failure to file in a timely manner.

Why You Should Track and Report Denied Claims

Tracking and reporting your denied claims will help you go back and analyze your files. To do this, make sure you are keeping consistent records of your data. Furthermore, keeping proof of your document submissions and changes will make denied claims easier to appeal. When you start tracking these files, keep in mind that tracking and reporting your denied claims will require specialized knowledge of your billing management system. 

 In conclusion, managing the process can be frustrating and time-consuming. Being able to optimize cash collections will help your medical billing company deal with issues effectively. If you would like to learn more about how to best handle denied claims, visit our website or feel free to contact us with any questions.



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