Claim rejections are amongst the key reasons that negatively impact the bottom-line of a healthcare organization. Consider the below statistics.

Mind-boggling Medical Billing Statistics You Should Know!

With a strategic approach, Claim rejections can easily be prevented. Though achieving a zero percent claim rejection may be near impossible, reducing claim rejection even by a fraction of a percentage would have a significant impact on your revenues. To prevent claim rejections, it is essential that we understand the most common reasons for rejections and take necessary action to avoid them in the future.

Top Reasons for Medical Billing Claim Denials

Below are the top reasons for claim rejections.

1. Missing Claim Details. Leaving just a seemingly insignificant little detail could result in claim denials. Technical errors like missing modifiers, incorrect codes or social security numbers alone account for a whopping 62 percent of initial claim rejections and 41 percent of write-offs.
2. Resubmission of Claims multiple times for the same care service is among the top reasons for a staggering 32% of the total number of claim rejections
3. Service Already Paid. This is another common mistake when benefits are included in multiple claims for another previously settled service.
4. Not Covered by Payer. Payers have different coverage and payment structure. Medical billing denials happen for the simple reason that the insurer does not cover the particular procedure. Hence, prior authorization and eligibility verification are significant processes that can prevent such denials and set clear expectations on patient responsibility
5. Filing Limit Expired. Most Payers have a time limit to submit claims after service, beyond which the claims may get rejected. Fixing coding errors are amongst the major factors that cause time delays. Healthcare tech experts suggest adopting automation strategies to accelerate the pace and accuracy of coding and billing processes.

Working on claim rejections and adjustments increases operational costs, while significantly impacting cash flow and revenues. That’s why, Hospitals and Medical Practices need to take a proactive approach to improve efficiencies.

• Segment Claim Denials based on the Physician, procedure, payer and other critical criteria. This level of segmentation provides actionable insights through business intelligence reports.
• Track and Measure the revenue cycle process by evaluating and determining solutions needed to address the rising issues
• Improve Quality of Patient Data by leveraging the capabilities of automation, forms and digitized processes that improve accuracy and speed of data collection
• Do a Thorough Research to identify the real reasons for claim rejections that happen beyond inaccurate billing and incorrect documentation
• Prepare a Comprehensive Billing Strategy that includes various components in the billing cycle like patient access, patient responsibility, price transparency and others
• Maximize Medical Billing Software to ensure that the latest features and functionalities are leveraged to improve your claims management process
• Leverage Automation to use predictive analytics to identify possible denials and fix them even before submitting claims
• Work with Payers to prevent miscommunication or missed documents that most often result in claim denials. Ensure that you harness the power of analytics to identify potential errors and trouble spots

Final Words

With constantly evolving regulations and guidelines, it is quite a challenge for Hospitals and Medical Practices to effectively manage the revenue cycle processes. Outsourcing to Medical Billing Companies like SolvEdge can be a strategic solution to prevent claim rejections. Our revenue cycle team comprises of SMEs, technologists, strategists, certified and experienced billers and coders who work together to maximize your revenue cycle performance. To learn more about how SolvEdge’s Medical billing services can help reduce rejections and drive up your revenue cycle curve, talk to our team.