5 Tips to Help Prevent Denials in Private Practice

5 Tips to Help Prevent Denials in Private Practice

You care about helping people, that’s why you’re in the medical field. Getting people the care they need is what it’s all about. However, denials from payers disrupt your ability to help anyone. 

Every practice struggles with denials, but the best billing departments can get this number down to as low as 3% or lower. Billing denials pose a serious threat to the income of your business, but most are preventable by simple changes. 

Don’t let claim denials continue to disrupt your office efficiency and revenue. Check out this list of tips that successful private practices use to mitigate the risk of bill denials.

1. Learn From Previous Denials

Categorize and document all the data you can about denials. Understanding why you’re being denied is the first step to stopping it. Setting up systems to accomplish this may take some effort, but understanding under what circumstances denials happen is a priceless tool to be used in preventing them from happening in the future.

2. Be Specific

Often claims can be denied due to generality, allowing the insurance provider more latitude to interpret the claim. Code diagnosis with the highest degree of specificity possible. Provide as complete information as you can, that way your claim isn’t interpretable in a way that an insurance company can make it more beneficial to their bottom line.

3. Verify Eligibility and Coverage

If you don’t already obtain eligibility information before scheduling a procedure or appointment, your office should consider it. This is a great tool to weed out clear denials right away. Thus, leaving you with the option to seek a remedy before the patient has received the care. Since scheduling is done in advance typically, this can be done without any extra wait time for the patient. 

While getting prior authorization still doesn’t guarantee that you won’t find an unexpected denial, it can make it far less likely. Just remember that most authorizations come with a time window for which they are valid, so if this is done as part of the scheduling process, verify that the appointment meets that timeframe.

4. Be on Time

Late claims are typically denials. More business for the practice is great from the perspective of growth, but a backlog of claims is costly. Getting behind may not be something you foresee happening, but without proper safeguards, getting a little behind can turn into many claims being late. Multiple denials can be crushing, especially when expensive procedures have already been performed. Set up systems to verify claims go out when they should, and establish redundancies to regularly monitor that this will never happen.

5. Get Help From Experts

Analytics companies and administrative consultants deal with this on a regular basis. As the most common lost income area, some experts have gotten very good at troubleshooting these issues. Working with an analyst can not only help you establish systems that will monitor exactly why denials happen and ensure that they do not happen in the future but also lower your administrative headache with a plethora of tools to help streamline the entire process.

Learn More About Preventing Denials in Private Practice

At Gentem, we want to help people just like you. That’s why 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. In fact, we’ve seen all the ins and outs of claim denials to help you care for your patients. 

Schedule a medical billing assessment today, and our team can let you know exactly how much we can help and what we can do for you. If we can improve your revenue and eliminate denial headaches, you can go back to spending time doing what you love: helping people.

Are You Giving Your Patients the Experience They Expect?

E&B checks and cost estimates are becoming a ‘must-have’ but take time. See how to do AI-driven eligibility checks instantly, with estimates sent by text or email with the click of a button.

eBook Cover for 5-Must Know Metrics To Build A Thriving Medical Practice

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.

Subscribe To Our Newsletter

Related Articles

Eliminate your medical billing headaches today.