Avoid Claim Denials with Outsourced Medical Billing Services Today

You face enormous pressure on your bottom line from wage inflation, rising costs, and declining patient and service volumes. And claims denials only make it worse, leading to an average annual loss of $5 million for healthcare practices, which can account for up to 5 percent of net patient revenue.

Today, the rate of denial is more than ever, increasing more than 20 percent over the past five years. In fact, many healthcare practices are now facing denial rates of 10 percent or more. A survey by MGMA found that denials increased by 17 percent. Industry averages show that nearly 20 percent of all claims are denied, and up to 60 percent of returned claims are never resubmitted. On top of that, reworking or appealing denials costs $25 per claim for regular practices and $181 per claim for hospitals.

You don't have to write off denied claims right away. In fact, up to two-thirds of rejected claims can be recovered with the help of an efficient outsourced medical billing service partner. Success and lower recovery costs depend on having a strategic approach that aligns with payer requirements. Fortunately, you can still avoid claim denials by knowing the frequent causes of claim denials.

Identifying the common causes of claim denials in your medical billing

You can reduce the fiscal impact of denied claims by preventing them in the first place. The key is understanding the most common reasons claims get rejected, according to the MGMA.

• Missing or incorrect information: Missing vital information like SSN, inaccurate plan code or technical error can cause denied claims and hampered cash flow for your practice.
• Prior authorization: You may face claim denials because of missing prior authorization approvals from your patients' insurance companies.
• Out-of-network provider: The payer may deny all or part of the claim if you are an out-of-network provider for a patient's insurance company.
• Duplicate claims: You will encounter claim denials if multiple claims for the same patient and service are submitted.
• Bundling: Instead of paying for two separate services, the payer combines them and pays one smaller fee.
• Missing filing deadlines: This happens when claims are filed outside the payer's required service date, and it should also be considered when reworking rejected claims.

Now, you must know how a professional medical billing company combats denials to ensure amplified revenue for your practice.

Perfect practices implemented by outsourced medical billing partners to combat denials efficiently

In denials management, knowledge is the key. To use that knowledge, you can follow best practices to stay organized and understand the root causes and impacts.

Know the exact stats: Knowing the initial denial rates, dollar amounts, and claim status helps you understand why denials are high and reveals opportunities to improve processes and fix issues.

Make sure your process is organized: You can't afford to lose track of denied claims—they hurt your revenue and create major administrative headaches. Stay on top of them with an organized denial management process that uses HIPAA-compliant tools to track claims efficiently.

Identify the trends and patterns: You need to track, analyze, and record denial trends to understand the root causes. Use data and analytics to fix issues, work with physicians and payers when needed, and consider outsourcing experts to cut denials and stay compliant.

Act quick: You need a clear process to fix denials—ideally within a week. With the right workflow in place, you can track claims smoothly from start to finish.

Communicate with payers: You and payers both benefit from fixing denials. Working together speeds up the process and improves efficiency.

Focus on quality over quantity: You can make the most of your time by focusing on claims already addressed. This ensures better-quality claims instead of a high volume of low-value ones.

Perform daily performance audit: You should audit remittance reviews, write-offs, zero-pay claims, registration, and insurance verification.

Learn from your past mistakes: You need accurate data to avoid claim rejections. Use payer ID lists in EHRs and track denial trends to spot issues and fix them faster.

Take the assistance of a clearing house: You need a strong clearing house relationship to streamline insurance processes and resolve rejections efficiently.

Understand your claims format clearly: Many billing companies use EHRs to submit claims in a standard format like ANSI837, making it easier to spot and fix denials. Understanding ANSI loops helps speed up the process.

Do regular follow-ups: You must track every claim so that you can correct your denied claims and resubmit them on time to stay away from facing revenue loss.

Build an efficient team: The reality is that most healthcare practices in the US healthcare market do not have adequate team members to handle their denial management part, thus ending up with an increased number of denied claims and revenue leakage. However, with an experienced team like us you can use the expertise to track progress, set benchmarks, and fix issues.

Sunknowledge advantages

With Sunknowledge, you get a risk-free way to improve your revenue cycle. Try our services free for 30 days before you decide! We guarantee to meet or beat any price or productivity, ensuring maximum value for your practice. Plus, we keep it simple—no binding contracts and an unbeatable rate of just $7 per hour.

Our real-time RCM experts offer you the following

• 99.9% billing accuracy
• 80% reduction on your current overhead costs
• A first-pass rate collection of 97%
• 100% HIPPA compliance
• Consistent tracking of submitted claims
• Dedicated account managers
• No-binding contracts
• End-to-end RCM service

Boost your productivity, efficiency, and revenue with our strategic denial management approach. Contact our experts today and let us handle your administrative tasks as your perfect outsourced medical billing partner, while you focus on patient care!