Medical Economics provides physicians key ways to fight payer denials, as almost 75 percent of physicians report frequent denials as an ongoing issue they face.
Here are eight strategies to note:
1. Avoid turning a blind eye to denials. If money is flowing into a practice, physicians may make the incorrect assumption they are not facing denials. However, most practices have a 5 percent denial rate. Providers should fight any denial average that exceeds that figure.
2. Study your numbers. Use data to assess why your practice faces denials as a good majority result from incorrect patient information. To avoid making this mistake, your practice should put a lot of emphasis on the pre-registration process and ensuring patient information is accurate.
3. Designate a staff member to continuously monitor details. Staying updated on denials allows physicians to better identify trends and strategize on ways to limit denials.
4. Employ a certified medical coder and a skilled registration clerk. Some providers also outsource their billing to ease the burden. If opting to go this route, ensure the outside firm's coder is certified.
5. Take note of scrubber edits. These edits provide warnings to providers if there are discrepancies in claims that may lead to a denial.
6. Keep your staff updated on denials and common pitfalls. Use past denials as teaching tools to improve your processes.
7. Become well-acquainted with each payer's contract details. Know the requirements that each payer has regarding claims to lower your denial risk.
8. Check a medications' formulary. Consider prescribing generics whenever possible.