In recent times, the claims denial rate of many practices has risen to unsustainable levels, soaring well above the industry standard of about 3-5%. The implications of high claims denial rates for a practice is far reaching as it hits at the core of revenue cycle performance; negatively affecting cash flow and dragging revenue growth. However, this does not have to be your center’s experience. Your practice can significantly reduce claims denial rates and witness a revitalization in revenue and cash flow growth. Here are 4 tips to help lower your denial rate:
1. Analyze the Causes of Your Denials
The first step to take in reducing denials is to conduct an analysis of your present denial rate and identify the primary reasons for the denials experienced by your practice. While reasons for denials vary in each circumstance, it’s important that you discover the root causes of denials. You might want to look at your current processes, your staff, or your technology stack to get to the root cause. This is very crucial because adopting strategies of high performing practices might not result in any significant improvement in your denials rate if the root causes of denials are not identified and addressed.
2. Minimize Coding Errors
Errors in coding represent one of the greatest cause of claim denials for practices. Previous and newly developed codes must therefore be verified to ensure they are free from errors. To achieve this, a practice might have to employ the services of expert coders and billers if it lacks expertise to handle it in-house. Expert coders and billers will be a great addition to your staff as they will help fix coding and billing errors that cause loss of revenue.
3. Educate Your Staff
Education and training of your staff on effectively managing claims collection and denial processes should be given top priority by your practice. Many claims denials can be avoided if employees are trained on the best practices. Significant training should be given to employees to ensure accuracy of data collected from patients as this forms the foundation of a best-in-class claims management.
4. Create a Claims Denial Unit
Creating a unit specifically dedicated to claims denial management will help your practice reduce its denials rate significantly. Operational efficiency is easily achieved when a unit in your practice is saddled with the responsibility of identifying, resolving, and proffering solutions to the causes of claims denials unique to your organization. This team should comprise physicians, coders, billers, software development experts, medical researchers, and members of the top management.