How to Prevent Medical

Billing Claim Denials?

www.mgsionline.com
 While ensuring efficient patient care, Providers and healthcare practices work
24/7 to improve their billing performance and revenue.
 However, the introduction of new medical reforms in the US healthcare industry
have complicated their goals.
 New coding techniques and insufficient training contributed to more claim
denials.
 It is estimated by the Medical Group Management Association (MGMA) that
even the exceptionally performing medical practices end up with 4% claim
denials.
 Then imagine the claim denial rate of developing healthcare practices.
 It is also estimated that almost 65% of claim denials are never
corrected and refiled.
 Even if healthcare practices take initiative and correct the denied
claims, they don’t submit before the time frame of 90 days.
 All these factors affected many healthcare practices’ revenue cycle
badly.
 In this article let’s see how we can prevent medical billing claim denials
and improve cash flow through efficient denial management
Analyze and Determine
the Cause

 Avoiding claim denials involves a series of

steps and the first one is to analyze and
determine what causes claim denials in
the first place.

 Right from the frond-end to back-end

services, there are several operations,
which if not carried out properly can
resort to claim denials. They are as
follows,
 Patient Registration

 This is the very first step when a patient visits a

healthcare practice and if it is not shown proper care,
then there can be a huge amount of claim denials.

 Front-office staff should make sure that they register

the patient details accurately while verifying their
insurance benefits and eligibility.

01
02 Coding:

 Accuracy in diagnosis and procedure codes is

crucial to proper denial management. Carrying
out the wrong diagnosis or coding incorrectly can
result in a lot of claim denials.
 It is for this purpose that healthcare practices
should offer enough training to their staff to carry
out unsurpassed medical billing functions as per
the new coding techniques.
 Billing

 Sometimes, staff submit duplicate

claims meaning they file a claim for a
03
service more than once.
 Such internal mistakes are perfectly
avoidable and the denial
management team should check
twice before the claims are filed.
 Filing

 Claims have a certain time limit before

which they have to be filed.
 The time limit varies from payer to
payer.
 Insurance companies will deny the
claims simply if they are filed beyond
this time limit.

04
 Payer:

 After analyzing all the factors, if there

are no mistakes from the Providers’
05
end, then the denial management team
must look into the Payer.
 Sometimes, payers make errors while
processing the claims.
 If so, then call the respective insurance
company and address the issue.
 Prioritize

06  Once Providers fix the root cause of their

claim denials, they should set up a good
denial management team.
 The team will further analyze which factors
cause the highest impact and prioritize.
 The causes are then eradicated one by one
in the order of the prioritization
 07
Claims Management Software

 Yet another important step in managing

claim denials is setting up a proper claims
management software in to your system.
 The denial management team should use
data analytics and study the pattern of
claim denials to optimize the software and
offer great solutions.
 This enables healthcare practices avoid
claim denials in the future.
 About MGSI:

 All the aforementioned steps can be done proficiently by a reputed 

medical billing company. 
 Therefore, partnering with one will save ample costs for healthcare
practices.
 If you are looking for a highly-experienced organization then look no
further than MGSI, a one-stop-shop to all your medical billing needs.
 This Florida-based company has more than 20 years of experience
providing exceptional denial management services to its clients.
 To learn more details, log on to www.mgsionline.com.
 Thanks!
Does anyone any questions?

Mail us: info@mgsionline.com

Call us: +1 813 666 0028
Website: www.mgsionlne.com
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