Evolving regulations have led to a paradigm shift in healthcare and leave no room for claim inconsistencies. That’s why hospitals and practices need to innovate new strategies and policies to improve claims accuracy.

Here are ten key strategies that can help reduce claim denials and improve your organization’s financial outcomes.

1. Get the Documentation for Patient Information in Place

Right documentation enables your coding team to appropriately assign codes which helps in better and faster reimbursements. Ensure that you provide more in-depth details on not just the diagnosis but the patients’ historical health information as well. Also, when an external team provides the diagnosis, ensure that they have the updated CPT and HCPCS codes. Outdated codes are more likely to end in claim denials.

2. Stay on Top of Your Payers’ Payment Policies

Know about the modifiers that they accept. You need to know if you should be using a -50 modifier or –RT and LT for a certain procedure. Learn and understand the procedures that your payer will cover and what they will not. Know if the payer will cover medical screening and understand if they deduct payments on the occasion of multiple procedures. A proactive approach to payer policies can make a huge difference to your reimbursement.

At SolvEdge, our medical billing teams are well-equipped with the latest industry updates and payer websites. They also establish strong business relationships with the payers, thereby helping the key stakeholders be well-informed of the latest updates and process changes.

3. Know the Pre-authorization Guidelines and Requirements of Each Payer

It is essential that you accurately document the pre-authorization information so the claim denials can be appropriately evaluated and noted down for the physician’s reference later. Streamlining the pre-authorization process is one of the significant steps involved in medical billing services.

Read More : 5 Key Strategies to Effectively Streamline and Overcome Prior Authorization Burdens

4. Stay Abreast of Your State’s Payment Policies

The clean claims policies differ with various states where some state guidelines have mandated claim reimbursement within a short span of time. It helps to know these policies in instances when the payer delays payments beyond this time period, your billing team can go ahead and charge interest rates on late payments.

5. Verify Patient Information and Document Them Appropriately

Patient demographic information is a key component of claims and reimbursements. To maintain an efficient billing cycle, it is critical that your medical billing team constantly verifies these details and updates them for future references.

6. Ensure That Your Billing Team is Conversant in Medical Billing Software

Latest medical billing and coding software solutions offer advanced features that include deploying business rules to identify and resolve claim gaps. The SolvEdge healthcare billing team comprises of certified and experienced professionals who closely work with our clients to improve the quality of claims and speed up the reimbursement and revenue cycle process as a whole.

7. Eliminate Human Error Through Claim Scrubbing Software

A technology with inbuilt scrubs and edits reduces costly human errors. Simple errors such as missing demographic details or misspelled names can lead to claim denials. An automated solution reduces the burden on in-house staff and cuts down on errors in the claim.

8. Build A Framework

It is best practice to have a checklist that needs to be ticked off before claims are sent to insurers. Also, internal claim audits help in standardizing processes and improving first pass claim acceptance rates. It is imperative that a strategic framework is in place and revenue cycle staff are abreast of latest legislation, technologies, and processes. Developing CEUs can have a strong positive impact.

9. Analyze Claim Rejection Patterns

Utilizing predictive modelling prevents recurrent claim issues. It bubbles up anomalies and offers fresh insights. Studying rejection patterns closely enables revenue cycle teams to resolve persistent issues that affect the CCR of hospitals. Categorizing the cause of claim rejections translates to better management of claim inventory.

10. A Clean Claim is Everybody’s Responsibility

A claim can be impacted at all stages of the revenue cycle, front, middle or back, and it is crucial that there is clear communication and transparency across departments. Technology that enables communication across all teams is vital to maintain a healthy claims cycle. According to HFMA, the CCR (clean claim rate) of a healthcare organization indicates the efficiency of its clinical documentation and revenue cycle processes. Maintaining a high CCR is lowers denials, AR days and rework. It is everybody’s responsibility that the claims that go out meet a stringent quality threshold.

Also Read:

Key Medical Billing Service Strategies to Optimize Eligibility Verification

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9 Proven Medical Coding Strategies You Don’t Want to Ignore

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10 Reasons to Consider Outsourcing Revenue Cycle Management Services

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Medical Billing Guidelines: Everything you need to Know about Medical Billing Reimbursements

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8 Questions to Ask Before you hire a Medical Billing Company