Healthcare Claim Denial Management in Medical Billing | EMR Experts

Medical billing denial refers to an insurance company’s refusal to reimburse the medical practitioner for services provided. Billing denial can be costly for a medical practice, which is why denial management in healthcare should be a priority.

In 2019, insurance provider denial rates ranged between 1% and 50%. Each medical claim that has a soft denial must be corrected and appealed. Reworking a claim can be costly, and an appeal doesn’t guarantee reimbursement. Hard denials cannot be corrected and must be written off.

This article will explain the most common reasons for billing denial and ways to manage it.

The Most Common Types of Medical Denial

Once you know the most common reasons for medical billing denial, you are half-way to overcoming the problem. The most causes of denial include:

1. Non coverage of a particular service
2. The patient has not met their deductible
3. Patient needed a referral
4. Claim has insufficient information
5. A different insurer covers the claim

• Contractual obligation: This denial occurs when the healthcare provider fails to meet the terms of their contract with the health insurance company. This may happen when:

1. Late filing of the claim
2. The claim has already been reimbursed
3. The physician provided too many services
4. The provider has not certified at the time of the service.

• Duplicate billing: A duplicate bill for a consultation then your medical billing software automatically creates another bill for the same service.

Keeping Track of Medical Billing Denials

If you want your practice to run smoothly without losing money due to billing denials, there are certain fundamentals that you need to take care of:

Denial Management Solutions for Medical Practices

The fundamental approach in managing denials is to use a software solution to handle your billing for you instead of spending hours reworking claims and handling appeals. The software enables you to work a claim with just a few clicks ultimately.

Software solutions store each patient’s Explanation of Medical Benefits (EOMB), so you can analyze claims and remittances and create documents in support of appeals. Other typical features include highlighting denial trends, tracking the success of appeals, and automatically importing ERNs.

Contact us today if you would like to find out more about how our software solution can help you implement denial management in your practice.

Originally published at https://www.emrexperts.com.