Common Reasons That Causes Claim Denials

It can get frustrating when claims are denied, but if the incident keeps occurring in your healthcare facility or organization, you may want to take a look at your processes and the way they are handled in your office. Timing issues, errors, and input oversights are among the reasons why some claims are denied. By being mindful of these incidents and following HCC medical coding standards, you could minimize denials and improve your approach to billing.

Hierarchical condition category (HCC) and risk adjustment coding is the payment model that identifies patients with chronic or serious illnesses, then designates a risk factor score to them according to factors like demographic details and health conditions. HCC medical coding was implemented in 2003 and mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. A patient’s health condition is identified using ICD-10 (International Classification of Diseases-10) diagnoses, which you submit to insurance companies when filing a claim. There are over 9,000 ICD-10 codes being mapped to 79 HCC codes.

HCC medical coding errors are among the reasons why claims are denied. By working with a seasoned team of AAPC-certified medical coders, you could minimize those mistakes and increase the accuracy of your claims. All coding must be audited before the charts are finalized. Claim denials may also occur when the claim is not up to the insurance company’s standards.  So, you need to make sure that the claims are made according to their regulations and that they are legible, specific, and complete with all the information required.

Missing information is another reason why a claim can be denied. Even a small detail left out can cause problems later on, especially when you are dealing with a detail-oriented insurance company. Keep in mind that some payers will look for minor specifics, such as the date of the medical emergency, onset, and the accident. A claim can be denied if it is not filed on time. Some providers of HCC medical coding services have a team of specialists who will make sure that the claims are submitted on time.

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Accounts Receivable Management: Top Tips to Get You Paid

As much as you want to get paid immediately, there are unavoidable circumstances that might prevent Insurance Company from paying you on time. In some cases, you might encounter an insurance company denying a claim. While there is no way to ensure that all claim can turn into money, you can minimize denials and inefficiency by considering account receivable management. It may sound complex, but it is actually simple when you work with the right billing partner, which you can outsource to save money and effort. Here are some tips to make accounts receivable management work for you:

• Outsource the service – An established and reputable medical billing company will provide you with an effective and highly trained AR team that can address the challenges in your cash flow. Their goal is to help you recover the funds owed to you as quickly as possible by accelerating cash flow and minimizing accounts receivable days by providing clean and error-free claims. They can analyze denied claims and regularly follow-up with patients and insurance companies on your behalf in case of any outstanding dues and claims.
  
  
• Do not wait – Go after late payments as soon as you notice them. The longer you ignore them, the more difficult it will be to collect. Accounts receivable management can help by following up, so you can focus more on your business.

• Follow-up insurance – Medical billing companies and healthcare providers lose money due to their inability to follow-up on any outstanding claims. When you lack manpower and the time to process insurance claims, you could risk losing a lot. So, consider working with a good Account receivable management team for assistance. Medical billing partner can aggressively follow-up all accounts with insurance companies to ensure the quick settlement of claims. They have the ability to monitor accounts receivables, too.
  
  
• Clean-up old accounts – Unresolved accounts receivables occur due to insufficient follow-up as a result of low manpower and backlogs. Account receivable management still analyzes previous reports and come up with ways to reduce debts and maximize collections.

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