Having clear policies and processes for handling claim denials can improve the bottom line. Often denials are returned to the payer without identifying the reason for the denial. In order to improve denial rates, the practice should start tracking denial reasons and identify the preventable errors such as:
• Were member and group numbers entered incorrectly?
• Were insurance cards unchecked or out of date?
• Was demographic information entered incorrectly or not updated?
• Was the CPT or ICD-9 code entered incorrectly?
To implement tracking denials you must assign a staff member to identify and document the reasons for every denial. Some practice management systems can track denials for you, but if your practice management does not have this, then the staff can track the information on an excel spreadsheet (many practices use denial codes for easy entry and tracking). Once the data has been accumulated, identify the preventable denials and have the staff work on improving these errors by improving processes within the office. For example, when the collectors receive denials, the reason for the denial should be shared with the billing staff so it can be corrected. It is imperative that the billing and collecting staff meet monthly to share information that will improve collections and thus increase practice revenue.
With consistent tracking, practices can identify the cause of the denials, make appropriate process and policy modifications/improvements, and reduce the number of preventable denials.