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How Does A Medical Billing Company Prevent Claim Denials?

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The main drawback of every medical practice is the excessive amount of claim denials. Therefore, they readily consult with professional medical billing to streamline their revenue cycle management in the right way. Otherwise, if they stick to traditional procedures then will have to deal with great revenue loss due to payment denials. Generally, medical denials occur due to the following reasons;

  • Unverified or terminated health insurance policies.
  • Outdated database inputs.
  • Invalid information about patients.
  • Incorrect medical codes.
  • Wrong payment credentials.

According to expert medical billing specialists, these mistakes not only cause claim denials and affect financial status but also impacts the payer-provider relationship. Therefore, they need the professional assistance of an expert medical billing company that encompasses a well-structured system for medical billing and coding procedures. Practitioners should shift to an accurate and reliable medical billing solution to resolve their revenue-related issues and grow their business.

Hence, it is a wise decision to work with a licensed and competent medical billing agency. With extensive industry experience and in-depth knowledge, a well-established billing collection agency can help you encounter these challenges and drive better business outcomes.

A specialized billing company can add value to the financial status of your business in the following ways;


1. Reinforcement of Electronic Health Records:

It is essential to keep a secure and well-organized system EHR to have a backup record of millions and trillions of patients. It is considered to be the primary responsibility of any experienced medical billing company to implement, manage and execute EHR to safeguard your patient’s information.

In this way, they can help you transform your manual and relevantly slow billing transactions into automatic and fast revenue cycle management services. However, no matter if you are handling a patient’s healthcare information (PHI) or electronic patient’s healthcare information (ePHI)_ it is mandatory to comply with data security protocols defined by HIPAA (Health Insurance Portability And Accountability Act). Therefore, medical practitioners should carefully partner with a reliable agency that provides the state of the art software and highly secure services.


2. Verification of Individual Information:

A well-experienced medical billing agency understands the significance of accurate documentation and guides your staff to streamline their administrative tasks.

Despite this, they also guarantee to reduce the overall ratio of claim against the denials. Hence, they strive to increase claim success rates and bring more revenue in return. They have a sufficient workforce of dedicated account managers that only supervise your billing transaction but also guide you to maintain records and reports.

Just like medical expertise, a professional medical billing company makes sure the effectiveness of the entire revenue cycle management system. They always stay informed of the real-time updates related to the policies, industries and requirements of current medical billing and coding regulations.


3. Timely Claim Submission:

It is essential to stay up to date and compliant with insurance payer’s rules. Therefore, medical billers should file and submit claims within the date related to the authorization of payers. Besides working in the given timelines, an organization should also resolve the problems regarding the claims by effectively communicating and coordinating with the insurance payers. In that case, it is difficult for physicians and medical staff to find time in order to responsibly indulge in administrative tasks. Although, a dedicated team of medical billing specialists requests the payer by calling or sending them an email reminder for the sake of verification. 


4. Appeal Denials Before Deadlines:

It is one of the most time-intensive and daunting tasks to identify and eliminate the reasons for claim denials. Therefore, practitioners must acquire the help of knowledgeable personnel who can monitor the denials percentage very closely to implement a denial recovery strategy.


5. Organize Denials Into Specific Categories:

A professional must measure the number of denials and categories by reporting, measuring and tracking them. For that purpose, an innovative medical billing company provides compatible business intelligence, that not only analyzes the denials but also categorizes them in terms of payment recovery management. Therefore, it is worth time and investment in order to get back your thousands of millions of dollars that are left uncollected on the table due to excessive claim denials.


6. Avoid Incorrect Information:

Medical providers are paid only if they file a “clean claim” to earn reimbursements. A clean claim only consists of accurate information and medical codes. Therefore, providers should ensure that their billing department just relies on correct data and information while avoiding any incorrect presumptions and suppositions. Just explain the correct details of claim denials that are based on generic coding protocols. Then you should realize the root cause of the problem that caused claim denials. 


7. Improve Collaboration With Payers:

It is difficult for physicians to stay on phone calls and monitor their medical claims till reimbursements. Although it is the necessary requirement in order to execute revenue cycle management according to the contract requirements. Since, different insurance payers can sometimes deny claims for invalid reasons. Therefore, it would be difficult for medical staff to track down the record of single claim_ from preparation to submission. Then identify the problematic areas, eliminate errors from the existing system, update the system and then request for appeal. Therefore, having a reliable medical billing company in place, allows you to get stress free from this administrative while dedicated and knowledgeable resources proceeding with your revenue cycle management. In this way, you will not only be able to generate maximum revenue but also successfully improve coordination with insurance payers.

Are you looking for professional assistance to reduce risk for claim denials? Medcare MSO is the nation’s most trusted medical billing company ready for your help. Click here: to visit our website and request a free demo to outsource medical billing services in reliable hands.



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