In many fields, the old saying “the best defense against all evil” has been used.
You must exercise caution when filing insurance claims to ensure the highest acceptance rate. Even if everything is correct, there are many reasons why insurance claims may be denied.
A lower percentage, despite the fact that it is more expensive, could be due to insufficient code usage or incorrect use of modifiers.
According to the American Medical Association (AMA), insurers deny between 1.38 and 5.07 percent of claims. According to the Medical Group Management Association, even the most skilled practitioners can have a 5% rate of denial.
Your medical practice will lose revenue if it fails to address insurer denials. Although it is easy to point fingers at others, it is crucial for pathologists to find and optimize proven methods to get claims paid.
Let’s talk about some proven methods that can help to avoid denials when you Outsource Pathology medical Billing Services.
Find the root cause of billing denials
A 2020 Change Healthcare study found that the majority of claims denied for the fourth year in a row were due to problems with patients’ eligibility or registration for the services. This includes denials of services for patients who have exhausted their maximum benefits and issues with benefits coordination. To see the most common issues, examine the data regarding your pathologist’s claim denials. Automating the processing of this area can help to avoid many problems, especially when it is combined with an effective staff education program.
Start with the most important issue
A small amount of claim denials could be stopped in your practice. This can have a major impact on the revenue cycle. Once you have identified the root cause of denials, it is time to crunch the numbers and determine the issue that has the most impact on revenue. Analytics can be used to identify trends in denials by payer, procedure or department. Prioritize revenue loss-causing issues before you address less urgent billing or coding issues.
Make the most of technology
Predictive analytics has been recognized for its role in reducing denials in billing departments and pathology practices. This software allows you to review your claims and flag any that may be denied. You can then address the potential issues before sending the reimbursement request. Although high-tech tools can be costly, many pathology practices who use them find they have significantly increased profits and decreased their need for pathology billing and claims.
Create an Appeals Process
Pathology billing providers lose 65 percent of the cases they attempt to appeal denied claims. This leaves money on the table. Although it may seem counterproductive to devote resources to the lengthy appeals process, it often yields a substantial return. You can streamline appeals by creating a solid protocol. This includes a cheat sheet with information about each payer’s appeal timeline. You can create dedicated templates for payer appeal letters for your most common denials so that you can fill in the necessary information and get paid faster.
Use to Verify Eligibility
This is also the costliest pathology billing denial. The insurance company rejects all claims and not just one code. No matter how recent the patient received care, staff members must be trained to verify patient information and demographics at each visit. It is important to verify and collect accurate patient data. Before administering any treatment or service, it is important to verify eligibility using patient-provided data.
Make a Strong Case For the Claim
To support your payment reasoning, attach any necessary documentation, such as documentation of service, a record about the original claim filing, and copies from the CPT assistant or CPT book that explain the proper use of the code. Keep track of all times and dates you spoke with, as well as all correspondence and submission dates. Keep a detailed record of all the commitments made by the representative of the carrier and hold them responsible if necessary.
Denial of pathology claims is a common source of frustration for billing staff. It can also have a significant impact upon your practice’s cash flow. Respond quickly to denials to determine the appropriate action and keep patient’s best interest in mind. Do not let denials pile up. To manage denials, you can connect with Medcare MSO as your Outsourced innovative Pathology Billing company.