How to control Claim Rejections via Best Revenue Cycle Management Companies

Do you think it’s fair for your claims to be rejected after hours and days of hard work? Best revenue cycle management companies continue to endeavor its services by not allowing healthcare professionals fall into revenue loss.

Any healthcare professional can experience constant revenue flow when the denial and rejections rates are low. It enhances the root cause for positive revenue flow with an ability to collect revenue reimbursements.

Best revenue cycle management companies helps healthcare professionals or healthcare organizations to maintain and submit clean claims without any rejections due to undiscovered errors.

How are Rejections caused?

  • For an instance where the claims are submitted in the paper based form, there might be chance for rejections in the form of Explanation of Benefits (EOB) or letters.
  • Paper based claims are least prioritized and of course least preferable to submit the claims where healthcare professionals have no other choice but depend on the payers.
  • Insurance companies have their own scrubbers to detect the errors in the submitted claims, it makes easy for insurance payers to detect errors before processing the claims and pushing them into rejections.
  • As these errors are scrubbed before processing the claims, insurance companies will more likely not have the record of scrubbed claims.
  • Best revenue cycle management companies will receive a notice and the necessary corrections will be mentioned to resubmit those claims once after corrected with accurate details.
  • Electronic claims: Almost every clearinghouse will have their own portals which allows to identify rejected claims.
  • Best revenue cycle management companies will have billing team to take care of the rejections to recorrect them and resubmit these claims within the portal.

Timely Response is very Crucial:

  • It’s important for healthcare professionals to respond to the rejections as soon as possible which otherwise would result in payment delays.
  • These payment delays would rather also take the position to bring a huge loss of revenue for the healthcare professionals as well as the healthcare organizations.
  • Every insurance companies will have their own timely filing limits according to their policies and regulations.
  • Best revenue cycle management companies and healthcare professionals are compelled to stay and follow the policy regulations in order to succeed in the medical billing industry and reap revenue payments without any loss.
  • If the healthcare professional fails to resubmit the claim within timely filing limits, it’s more obvious that payments will not be cleared in shorter duration of time.
  • Regular tracking on claims and paying attention to the aging reports of the claim can help in getting information about the claims and resubmit the corrections according to payer’s timely filing limits.

The most common reasons for Rejections:

  • The most common and frequent reason for rejections of claims is the input errors or mistakes in patient demographic entry as well as eligibility verification.
  • The incorrect information in the patient demographic entry include, incorrect insurance payer’s ID number, incorrect member ID number, incorrect Date of Birth or a misspelled name.
  • So, best revenue cycle management companies must aim to triple check for the errors in the claims before submission to avoid rejections once the claims are submitted.
  • Errors in pre-authorization is also a difficult problem observed over the years.
  • By obtaining important information and documents in hand becomes extremely hard and critical to verify and correct spelling, Date of Birth, address, Insurance companies’ number and verification of first and secondary payers.

What does Clearinghouse do?

  • By using clearinghouse for submitting the claims brings healthcare professionals several advantages.
  • Clearinghouse has the capacity to scrub the claims and can identify errors before submitting them to the insurance companies.
  • Claim rejections are displayed clearly to the healthcare professionals and best revenue cycle management companies to view, correct and resubmit them within timely filing limits.
  • Clearinghouse keeps updated on the renewal of insurance policies and new insurance companies specific requirements, new medical codes and patient eligibility requirements.

How to avoid Claim Rejections:

  • Whether it’s healthcare professionals or best revenue cycle management companies, there are few steps to follow to manage rejections and denials.
  • Best revenue cycle management companies must track and analyze the trends in insurance companies’ claim denials and rejections.
  • Differentiate these denials and rejections accordingly and work efficiently to fix these errors as soon as possible.
  • Expert medical billing team from best revenue cycle management companies is essential to handle rejections quickly and also preventing them from occurring in future.
  • Scheduling routine chart audits for data and documentation quality to detect errors and problems before claims are submitted to insurance companies.
  • Contact insurance companies to check and eliminate contract requirements that leads to denials and overturned appeals.
  • Automated software technology enables and optimizes claim management to flag potential denials before submitting the claims.
  • Consistently keep an eye on eligibility verification process throughout the procedure if the treatment or procedure is eligible for the service and if it helps in reimbursements.
  • Prioritizing areas with large impact such as troublesome insurance payers and issues contributing factors, possibly leads to redesign full process.
  • Review these claims throughout revenue cycle management process and ensure the updated rules and regulations and recorrect errors.
  • Constantly check on the following for avoiding rejections:
  1. Missing of pre-authorization codes and expiration.
  2. Unsupported medical necessity of documents
  3. DRG downgrades
  4. Treatments and procedures such as scans and 3-D mammography.

Tips to reduce claim rejections:

  • Review the notifications carefully without any delay which acts as one of the most important aspect in claim submission process. As soon as remittance advice is received, review the explanation of benefits and insurance notifications very thoroughly and keenly.
  • The notification should contain the details of the claim whether it’s denied or partially paid or totally paid or rejected. If the information is not in detail, it’s the duty of healthcare professional to call the insurance company to know the reason.
  • Being persistent is essential because if the claim is rejected for unsatisfactory reasons, there’s a chance for healthcare professional to appeal the claims. In order to do that, they should be sure about the information required for an appeal.
  • Never delay your claim submission process. It’s always crucial to resubmit claims within timely limits. If delayed, the previous claim with false or miss information will be considered for the process and rejected.
  • Better to understand about the appeal process in prior to the claim submission. Ensure if healthcare professionals are familiar with the appeal process. When they have good understanding with the insurance companies’ policies, then it’s easy to respond to their actions.
  • Don’t neglect the records. Keep all the information recorded and filed as it may require for further process. Store the information and look for the chances of taking them for an appeal.
  • Outsourcing can save healthcare professionals from all these disputes. Saving time and money could be more by also ensuring if the billing procedures are consistent.

Hope you got the information on rejections and how to prevent them. For suggestions, please comment below. We will consider them, if relevant. For more queries and updates on healthcare, please subscribe to our blog.

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