When it comes to managing your practice’s revenue cycle, avoiding claim denials is pivotal for financial stability and growth. However, even if you have an established Revenue Cycle Management (RCM) process in place, denial rates can persist. In this blog post, we will share four actionable tips to help your practice reduce claim denials and maximize reimbursements, allowing you to focus on providing exceptional patient care. 

Investigate the root-cause 

Correcting and resubmitting denied claims can be time-consuming and repetitive. The key to reducing denial rates lies in understanding the root cause of these denials. Take the time to analyze and learn from the denied claims. Identify patterns and trends to pinpoint where the mistakes are occurring, whether they stem from staff errors, technology issues, or automation glitches. By addressing these gaps, you can effectively lower denial rates and improve overall revenue cycle management. 

Be prompt and persistent 

Speed is essential in handling denied claims. Implement a process of reviewing denials within two business days and responding and re-filing within five business days. Utilize this time to thoroughly investigate the issue, create a plan, and gather the necessary resources for an accurate claim re-submission that will have a higher chance of being adjudicated appropriately. It’s important not to assume that all denied claims are erroneous. Payers often deny claims for minor issues, so persistence in reviewing and responding promptly can help decrease your overall denial rates. 

Rely on industry experts 

Consider assigning billers within your practice to specific payers or treatment specialties. This specialization enables billers to become experts in their assigned areas, leading to improved accuracy in diagnosis and treatment billing. Alternatively, organizing billers based on payers allows billers to cultivate relationships with specific payers, gaining insight into their payment processes and preferences. This knowledge can translate into submitting claims less likely to be denied. Additionally, invest in comprehensive training and education for your billing staff or consider partnering with outsourced billing providers to leverage their expertise. 

Automate for efficiency 

Incorporate automation and technology into your practice’s revenue cycle management. Explore modules within your practice management or Electronic Health Record (EHR) system that can optimize and automate various steps of the claims process. By implementing business rules and leveraging automation, you can streamline mundane tasks and enhance claim accuracy, ultimately lowering denial rates. Work closely with your practice management consultant to identify and implement customized business rules that align with your specific operations. 

Reducing claim denials is a critical aspect of revenue cycle management for healthcare providers. By investigating the root causes of denials, being prompt and persistent in addressing them, relying on industry experts, and leveraging automation and technology, your practice can optimize its revenue stream and promote seamless patient care. Aim to establish a practice with below-average claim denials and above-average patient satisfaction. Remember, if you need further assistance in managing your revenue cycle, MedCycle Solutions offers a range of services aimed at ensuring efficient revenue management and improved practice performance.