In an article published last year, we cited illegibility, lack of specificity, missing information, timely filing and varying payer standards as the five most common mistakes causing medical claim denials.
These prevalent errors combine to crimp the pocketbooks of physicians everywhere. Fortunately, adopting a quality practice management system will eliminate each of these errors from your revenue cycle.
Illegibility
Paper claims bring human variables into the equation, one of these being the legibility of a medical biller’s handwriting. Although some write so neatly they can pass for a typewriter, others can get sloppy, especially when trying to file claims quickly on a busy day.
Practice management software takes handwriting out of the equation since claims forms are filled out and submitted electronically.
Lack of Specificity
Insurance providers will deny claims that aren’t coded to the highest level of specificity. Coding to the highest level of specificity simply means using the maximum number of digits allowed for a particular diagnosis. For example, using a four-digit diagnosis code for a diagnosis that requires five digits will get your claim denied.
First-rate PM solutions offer code-scrubbing capabilities that can catch under-coded diagnoses and other coding errors. That way, your billers don’t waste time submitting claims that are only going to be denied.
Missing Information
Some payers deny claims if certain fields on the claims form aren’t filled out. Billers can easily bypass fields if they are rushing due to intense time constraints. PM software avoids this type of error by auto populating fields, which not only saves time but reduces the chance for human error during input.
Timely Filing
Getting denied for timely filing means your practice did not submit a claim during the timeframe allotted by a particular provider. Even if the claim is submitted perfectly otherwise, a strict provider may refuse to accept the claim after the timely filing date.
Since PM systems automate many parts of the claims process like rules checking, they eliminate almost any excuse for not getting claims submitted on time. In fact, an intuitive PM system should make it easy to submit claims at the end of each day with a few clicks of the mouse.
Claim Not Up to Payer Standards
This reason involves all of the above common denials and other less common denials. Certain payers are just more stringent when it comes to which claims will receive approval. With practice management software fixing problems automatically or at least identifying them, all claims should be perfect. And a perfect claim is something no payer can deny.
Remember, every denied claim costs your practice time and money during the resubmittal process. So, instead of dealing with each type of claim denial separately, your practice can fix them all at once by choosing the right practice management system.
