Denials are a source of frustration for all physicians. When left unmanaged, they’re also one reason why physicians ultimately sell or close their practices, says Dorothy Steed, CCS, CDIP, revenue cycle consultant in Atlanta.
Here are six tips to improve the denial rate at your practice.
1. Use a claim scrubber.
Most practice management systems include a claim scrubber that catches coding errors and omissions before claims are finalized. “Claims have become so complex, you really can’t keep track of all of the codes without some type of technology assistance,” says Tammy Tipton, owner of Appeal Solutions Inc. in Oklahoma City, Okla.
2. Stay up to date on coding changes.
Appoint a staff member to review annual coding changes and ensure that the EHR and/or encounter forms include these changes, says Sally M. Frese, MSN, RN, CPC, coding compliance consultant at First Class Solutions Inc. in Maryland Heights, Missouri.
3. Hire qualified coders.
Require a CPC credential, at least two years of experience, and a 90-day evaluation period, says Steed. If current staff aren’t able or willing to meet these requirements, consider moving them to an alternative role (e.g., the front office). “You could still retain them to perform other office functions, but they won’t have their hands in your finances,” she says. If the practice outsources the coding function, ensure that the vendor only hires credentialed coders, she adds.
4. Focus on clinical documentation improvement to avoid denials.
Physicians should ask coding/billing staff to determine what specific documentation the payer requires so they can provide that information going forward, says Tipton.
5. Don’t automatically resubmit denied claims.
Duplicate claims are one of the most common reasons for denials, says Tipton. Instead of automatically resubmitting the claim, ask coding/billing staff to contact the payer’s customer service to determine why the initial claim was denied, she adds.
6. Improve the patient experience.
Obtaining prior authorizations, for example, should be less of an administrative requirement and more about providing excellent patient care, says Tipton. “There’s so much emphasis now on patient experience, and I think that needs to be expanded beyond clinical staff to include other office staff,” she says. “Front office staff are the front lines, and they can make an impression on patients in terms of paving the way for quality care.”
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Photo courtesy of: Medical Economics
Originally Published On: Medical Economics
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