It is in
Wed ,30/06/2010It is in the insurance company?s best interest to deny a claim and force a resubmission for payment. This helps their cash flow and significantly impacts yours.
One study estimates that 90 percent of all claim denials are preventable. Healthcare Informatics website states that, “Of 15 billion U.S. healthcare claims, 25 percent to 40 percent are rejected or denied at some stages in the administrative process. Only half of those are followed up and resubmitted.” Newer medical billing systems can drastically help solve this type of problem.
Potential Solutions
Some electronic medical billing systems will now employ sophisticated Rules Engines that will check your claim before it is sent. Examples of some of the messages that you could see are:
Diagnosis Code Requires Onset Date
CPT: G0001 is invalid for the specified insurance company
Procedure Requires Referring Physician UPIN
These types of checks and hundreds more, can ensure that the most common errors will be caught before a claim is sent to the insurance company for payment. Reducing the amount of denials helps your practice in two ways. First, cash flow is increased due to faster payments. Second, the time required to look at a denied claim, research the problem, correct it, and resubmit it can be 5 times as long as the original submission time.
To ensure a smooth running billing operation by reducing the number of coding errors, insist on a claim scrubbing rules engine in your practice management system.
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