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How to Avoid Hospital Claims Denials

March 1, 2021
The American Hospital Association (AHA) surveyed more than 200 hospitals and health systems in 2019 to explore how commercial health plans employed utilization management practices for patients and providers.

AHA found that 89% of the respondents have experienced an increase in claims denials over the past three years. 51% of them even described such increase as “significant,” with the failure to obtain prior authorization as one of the major reasons for claims denials. 

Claims denials will not only impact your revenue performance but also the quality of the patient care you provide. In addition to identifying the root causes of your claims denials, it is crucial to consider leveraging the expertise of a medical billing and coding company to avoid delays and rejections. Coronis Health is a healthcare revenue cycle management company offering global capabilities and specialized solutions to all types of hospitals and surgery centers. Our seasoned team of tireless and tough negotiators goes after the last dollar, so you’ll receive timely, relevant, and accurate information in a way you can understand. We don’t just help you get money, we help you financially grow.

Why Are Claims Denials Up?

Knowing the common reasons for claims denials is key to preventing them. These are the top reasons why your claims are getting denied:

  • Failure to obtain prior authorization
  • Non-compliance with medical criteria
  • Non-compliance with procedures/eligibility issues
  • Invalid claim data
  • Unspecified billing issues
  • Downcoding
  • Missing or incorrect information
  • Outdated insurance information/use of out-of-network provider
  • Missing or invalid explanation of benefits
  • Services not covered

How Claims Denials Harm Hospitals 

Healthcare providers are focused on two things: providing patients with the highest quality of care and getting paid for that care. Denied claims, however, are a huge obstacle to receiving timely and complete reimbursements. Denials are not only time-consuming to process, but they are also costly to appeal since you will need additional labor and manpower for it. Furthermore, the time spent by your billing department in reviewing and resubmitting claims can slow down their productivity. As a result, denied claims can negatively impact your facility by reducing your cashflow, delaying payment for your services, and disrupting your team’s efficiency. More importantly, dealing with these frequent billing errors and mistakes can lead to physician burnout which results in patients having to wait for proper care.

Combat Claims Denials 

Handling claims denials is not easy without enforcing a structured plan. A comprehensive analysis of the revenue cycle can help combat claims denials and guarantee timely payments for the services provided. Streamlining your claims management process is key, and this can be done by employing new strategies in updating your systems, maintaining clean records, and using data analytics. By constantly having a team trained and experienced in claims management, as well as applying the best practices in medical billing, you can significantly cut down the rate of your claims denials and get more approvals faster. Below are ways you can combat claims denials:

Create an Improvement Plan from Claims Analytics 

You can address denials with an analytics-driven approach. This can help empower your staff to identify errors in the process that contribute to denials. One way to do this is by assessing your medical billing software and technology. See why claims are being denied, determine which tools and resources are helpful, and eliminate anything that is deemed unnecessary. Ask your employees which tools help them work more efficiently and what they need to help enhance their productivity. By analyzing your billing software’s step-by-step process, you can better evaluate your workflow and shed light on what areas need improvement. This will then lead you to create a strategic plan for fixing any errors and expediting your processes. 

Hire Expert Medical Billers 

When the efficiency and profitability of your revenue cycle are at stake, you need to have expert billers on your team to ensure your facility’s success. These experts will still need consistent training so they can stay up-to-date on the latest technologies and coding regulations. Maintaining this level of expertise on your staff can be costly and time-consuming, which is why many hospital facilities choose to outsource their medical billing to help free up their staff and leave the more challenging collections to the experts.

Expert billers are experienced, constantly trained, and knowledgeable about the challenges associated with denial management. As a result, patients can come to terms with their outstanding bills, your staff will no longer be burdened by unhappy patients, and your cash flow will significantly improve.

How Our Medical Billing Services Prevent Denials

With over 100 years of combined experience in various niches including hospitals of all sizes, Coronis Health offers customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. While most medical billing services just submit claims, our team’s process involves analyzing your system and determining the exact reasons for claims denials. We will analyze the collected data and create strategic solutions to help combat denials and increase your revenue. 

We also generate solutions from analytics from the billing software used. Our medical billing software works independently from your practice management (PM) system, meaning there is no need to change your current PM system. Coronis Health is well-versed in many of the top PM systems. Our proprietary medical billing and coding denial management software also tracks claim status, allowing us to improve your first-pass rate significantly. As technological innovators, we make sure that our software can identify medical billing trends, giving us the ability to avoid future denials before they happen and allowing you to collect timely payments for your services provided. Coronis Health will take care of everything for you. We will ensure your collections are easy to manage and denials are kept to a minimum.

Partner With Coronis Health

Coronis Health is comprised of the top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. We are adept in not only understanding client challenges, but creating effective solutions when it comes to reducing denied claims and improving your cash flow. If you are looking for medical billing services from a reliable partner who will be focused on cultivating your financial health, contact Coronis Health today.

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