{"id":8373,"date":"2013-08-06T17:00:14","date_gmt":"2013-08-06T21:00:14","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=8373"},"modified":"2013-08-06T17:00:14","modified_gmt":"2013-08-06T21:00:14","slug":"5-red-flags-for-claim-denials","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/5-red-flags-for-claim-denials\/","title":{"rendered":"5 Red Flags for Claim Denials"},"content":{"rendered":"

\n

Medical claim denials are a hassle and can lead to financial difficulties. But with keen eyes and a little know-how, many can be easily avoided.<\/p>\n

Brian Fugere, COO of RemitDATA, a comparative analytics provider, recently talked with\u00a0Healthcare Finance News<\/em>, a sister publication of\u00a0PhysBizTech<\/em>, to identify the top five most common claims denials.<\/p>\n

<\/p>\n

1. Duplicate claims.<\/strong>\u00a0Physician practices and hospitals are taking part in a common mistake which accounts for the largest percent of claim denials, said Fugere. Front office administrators are hitting resubmit after not hearing back from insurance companies, which resets the clock on the time it takes to pay a claim. Denial is inevitable in this situation. \u201cThis is a bad process some practices just ignore, but they really shouldn\u2019t.\u201d<\/p>\n

2. Claim lacks information.<\/strong>\u00a0Human error<\/a> impacts most practices but nowhere is this more prevalent than in claims processing. Basic information, such as a person\u2019s date of birth or spelling of a name, are common mistakes. \u201cThis is not a good reason to get a denial,\u201d said Fugere. \u201cThese should definitely be examined and resubmitted. Otherwise [practices] are just leaving money on the table.\u201d<\/p>\n

When these claims are denied, it almost always doubles the time it takes to turn around a claim, affecting the practice as well as the patient. Claims should always be examined closely, said Fugere.<\/p>\n

Fugere added that front-end scrubbers — technology that pre-screens claims — can help avoid this type of commonly made mistake.<\/p>\n

3. Eligibility expired.<\/strong>\u00a0Most practices verify coverage beforehand to avoid issues, but sometimes that doesn\u2019t happen. One of the most common claim denials involving verification is when a patient\u2019s health insurance coverage has expired and the patient and practice were unaware. Also, in a lot of cases, practices may check eligibility when an appointment is made, but between the appointment being made and the actual visit, coverage can be dropped. \u201cThey should do an eligibility check again once the patient has arrived,\u201d said Fugere.<\/p>\n

4. Claim not covered by the insurer.<\/strong>\u00a0Another claim denial that can be avoided with verification is when procedures are not covered by an insurer. Fugere said that practices and hospitals can easily avoid this problem by using real-time verification.<\/p>\n

5. Timely claims filling<\/a>.\u00a0<\/strong>Having the time limit expired on a claim is something that can cause a great deal of aggravation. \u201cIt makes small practice owners flip out,\u201d said Fugere.<\/p>\n

According to Fugere, this is the most easily avoided claim denial. \u201cThis is a really bad one,\u201d he noted. \u201cThey basically didn’t send the claim in time.\u201d Most practices concentrate on larger claims first, which means small money claims are put on the backburner. This causes a lot of small claims to be denied, which adds up to a lot of money.<\/p>\n

Frank Irving is the Editor at\u00a0PhysBizTech<\/a>, a publication of MedTech Media that provides business and technology intelligence to forward-thinking medical practices.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Medical claim denials are a hassle and can lead to financial difficulties. But with keen eyes and a little know-how, many can be easily avoided. Brian Fugere, COO of RemitDATA, a comparative analytics provider, recently talked with\u00a0Healthcare Finance News, a sister publication of\u00a0PhysBizTech, to identify the top five most common claims denials.<\/p>\n","protected":false},"author":1,"featured_media":32786,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[39],"class_list":["post-8373","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue","tag-revenue"],"yoast_head":"\n5 Red Flags for Claim Denials - Continuum \u2013 CareCloud<\/title>\n<meta name=\"description\" content=\"Medical claim denials are a hassle and can lead to financial difficulties. 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