5 Tips to Help Prevent Denials in Private Practice

5 Tips to Help Prevent Claim Denials in Your Private Practice

Every practice struggles with medical billing denials. But the best billing departments know how to handle claim denials and can get this number down to 8% or lower. 

Claim denials pose a serious threat to the income of your business. But did you know that most are preventable by simple changes? 

Check out some recommendations that successful private practices use to mitigate the risk of claim denials.

What are the Different Types of Medical Bill Denials?

Payers create different types of denials. Many will fall under technical, clinical, soft or hard denial. 

  • Technical billing denials occur when the payer needs more documentation. Usually, this type of denial happens when you don’t provide enough information to the payer.
  • Clinical billing denials happen when the payer disputes the medical necessity, level of care provided or the length of stay. These denials typically start as soft denials and move into hard denials.
  • Soft billing denials stem from minor issues with the claim. You can usually reverse a soft billing denial with some simple follow-up or by providing more information.
  • Hard billing denials usually require an appeal if you want the payer to reverse the decision. Sometimes, a hard denial will turn into lost revenue and a write-off for your practice.

Lost Revenue Calculator for Medical Billing

Find out how much revenue your practice may be missing with this free calculator.

Essential Tips to Prevent Claim Denials

1. Learn From Previous Billing Denials

Categorize and document all denial data. Understanding why the payer denies the claim is the first step to stopping future denials. Setting up systems to accomplish this may take effort, but understanding the circumstances that cause denials is a priceless tool in preventing them from happening in the future.

2. Be Specific in Your Claim

Often, a payer will deny a claim because it is too general. A vague claim can be open to interpretation, allowing payers to deny it and help their bottom line. Make sure you code diagnoses with the highest degree of specificity possible and provide as complete information as possible. With these steps, the insurance company can’t interpret the claim in a way that’s more beneficial to their bottom line.

3. Verify Eligibility and Coverage Before Scheduling Procedures or Appointments

Make sure your practice obtains insurance eligibility before scheduling a procedure or appointment. This is a great tool to weed out denials right away, leaving you with the option to contact the patient before they receive care. Since scheduling is typically done in advance, you can do insurance verification without any extra wait time for the patient. 

It’s also critical you get all prior authorizations before the scheduled appointment. While getting prior authorization doesn’t guarantee the payer will accept the claim, it is an essential factor in the claim review process. Just remember that most authorizations come with a time window for which they are valid. So, if you get prior authorization as part of the scheduling process, verify that the appointment meets that timeframe.

4. File Your Claims On Time 

Late claims typically result in a denial. While more business for your practice is great from a growth perspective, a backlog of claims is costly. If you have a large backlog and too many late-filed claims, denials can pile up and become a serious problem  mainly when you’ve already provided care or performed expensive procedures. Set up systems to verify claims go out promptly, and establish redundancies to monitor this timeframe regularly.

5. Get Help From Experts in Billing and Claim Denials

Working with an analyst or revenue cycle management (RCM) expert can help you establish systems that will find and fix denial problems in your RCM. They can also lower your administrative headache with tools that streamline the entire process.

Increase Revenue & Collection Rates

Gentem’s tech platform and team of billing experts increase practice revenue by an average of 20%. 

How Can an RCM Partner Help My Private Practice with Claim Denials?

At Gentem, we want to help private practices thrive. We’ve become experts at helping practices create solutions to demystify and empower their revenue streams. We know exactly what to look for to optimize your income. 

Using a combination of world-class automation and in-house experts, Gentem ensures clean claim submission that minimizes claim denials and appeals. Our team follows up on every single claim until you get paid.

Schedule a medical billing assessment today, and our RCM professionals can let you know how much money you’re leaving on the table. If we can improve your revenue and eliminate denial headaches, you can go back to spending time doing what you love: helping people.

WATCH: Mastering Front-End vs. Back-End RCM

Join Gentem RCM expert Jenn Vaughn for a deep dive into the differences between front-end and back-end RCM. Get critical best practices and tips for increasing your practice’s reimbursements and revenue.

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5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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