Reasons and Solution of medical billing denials

There are so many medical billing companies that can work for both small and big setups. However, no medical billing company enjoys having denials. The reason behind this is that when there is an increase in the medical denials, it affects the revenue cycle in a bad way and is also a sign that something is going wrong in your healthcare center. If we look into why these denials happen, then there are a number of reasons that are the cause of these denials. So to ensure the least denials in medical billing, the setup needs to look for the reason first and then its solution. Among all, some reasons for the denials are very common and are faced by almost all healthcare centers. The blog cover all these common reasons along with their solutions.

Repetition of Claim:

One of the most common reasons for a medical billing denial is a repetition of the claim. Many setups make the mistake to resubmit a claim that is already under process or processed earlier. To resolve this mistake, the healthcare staff or the medical billing company should keep track of all the claims. They should restrain from submitting any claim without proper checking. So whenever you submit a claim do get it checked with your reports to avoid denials.

The patient is not eligible:

It is very common that the medical billers don’t look for the insurance card of the patient every time. Not checking the card creates many problems and is a common cause of denials. As many patients try to use the expired insurance card so if not checked properly, it results in denial of the claim. So the only solution to avoid this claim is by checking the patient’s insurance card and taking its picture from both sides for the record, every time a patient visit is a hospital.

The physician is not on the network:

The third most common cause of denials is a lack of knowledge. Patients don’t keep in touch with their insurance company and don’t keep themselves updated regarding the current physician that is on the network. They get the claims submitted for a physician that is not on board which leads to denial. So to avoid this common reason, make sure you get yourself updated about the networks and other necessary stuff.

Missing information in the form:

There are high chances of denials because of human error. If you or the outsourcing company is not handling medical billing using software then there are high chances that the reason behind the denials is human error. Many times the biller miss to file the file properly which leads to denials. So make sure you enter all the insurance and other information properly. The information that needs to be entered correctly includes name, insurance number, vision, and much more. If you or the staff fails to enter any of the above-given fields incorrectly the file of the claim will go to the denial phase.

Wrong bundling of Service:

There are a number of healthcare services a patient goes through in his life. The assembling of each medical service vary. For example, X-ray needs to be filed independently however lab reports need to be bundled together while submitting the claim. The common reason for claim denial is that people don’t bundle these lab reports and bundle the report that should be submitted independently. To ensure a decreased denial rate of claims, one needs to ensure that he has assembled the report and files in an appropriate way.

Exceed  limit:

There are so many insurance payers that offer limited services. The patients cannot claim more than the visits the payer offers each year. So if you will submit the claim of the patient who is running out of limit, you will ultimately face the denial. The only solution to overcome these denials is to check whether your patient has any visits or services left for the year or not. If the patient is out of limit don’t process the claims and let the patient know.

Wrapping up:

If you have outsourced your medical billing to a company from the list of best medical billing companies, they may not have alot of claim denials. But in case the number of denials per year is increasing, then it’s high time that you look into the reason for your claims beings denied and look for their solution instantly. Above are some common mistakes or reasons along with the solution that will guide you in decreasing the number of denials. If you are looking for a reliable medical billing and coding company, contact billing freedom. It is the best company in Texas that is offering the most effective and reliable medical billing service at reasonable rates.