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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Rectify Your Patients’ Health Information with Document Management System

Administrative costs account for over 25% of the total expenditures of healthcare clinics and hospitals. A large portion of this goes to paperwork involved with billing, coding, records, and insurance. Each patient visit adds to the already voluminous paperwork healthcare providers have to deal with on a daily basis. What’s more is these medical facilities are obligated to maintain all these records for at least 10 years after any patient’s final visit. With the amount of information that practitioners have to manage, how do you ensure your own practice’s reliability, accuracy, and efficiency in keeping patient records?

Many healthcare providers are discovering the benefits of digitizing their patient records and other related paperwork and adopting the appropriate document management system, which, in a lot of ways help reduce the cost of paperwork management and at the same time ensure document processing speed and accuracy.

Cost efficiency is one of the most obvious benefits of document management systems. Facilities that have already switched to digital record keeping systems cut spending substantially in terms of reduced material and equipment costs, reduced storage needs, reduced retrieval fees, and smaller staffing costs. Well-designed document management systems also ensure information security and regulatory compliance. Paper documents are prone to damage due to natural disasters and accidents, ranging from mold to fires, flooding, and other incidents. Physical damage to paper-based documents are usually irreversible rendering patient information non-recoverable. Electronic document and file systems have redundant storage features and highly efficient disaster recovery solutions, making sure that all information stored can be recovered one way or another. Even when a particular server fails, there are digital backups that practitioners can turn to so important information can be recovered when needed.

Document management systems also provide a level of protection no paper-based file system can offer, that is a detailed chain of file custody, wherein timestamps and employee names are recorded on each stage of the document processing. This means extensive protection of patient information confidentiality.

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