Reviewing your revenue reports and noticing your denial rate is through the roof? Your first instinct is probably to point the finger at the billing department. True, billing is the heart of the revenue cycle. However, there are lots of other places things can go awry and cause a denied claim. Today we’ll review four often forgotten areas that denied claims could stem from.
It All Begins at the Front Desk
The revenue cycle begins at the Front Desk, and there are many opportunities for things to go wrong. For example, missing or incorrect contact information and end up in a claim denial, as can errors in eligibility and authorization. If you find that denials stem from your front desk, the chances are that your staff could use some training. Be sure there is a process in place and that all front desk staff is well versed in that process and how to enter that into the system correctly. If your team is on point and you are still having issues with front desk denials, you may want to consider adding more staff to ensure all details are captured correctly. Adding one new staff member can be costly but not if it saves you money in denials down the road.
Coding – Where it Counts
In a perfect world, there is a constant communication flow between coders and clinicians to ensure everyone is aware of the information needed to assign correct codes and avoid denials. Alas, this is not what it’s like in the real world. The top 3 coding-related errors include Diagnosis, Treatment, and Procedure Errors and Modifiers. These denials alone could be costing you thousands of dollars per year or even each month! One of the easiest ways to combat this is by retaining skilled medical coders; however, the buck does not stop there. It is absolutely vital to make sure your providers are consistently trained on coding protocols. From day one, the importance of timely and accurate coding should be stressed. Few Physicians enjoy these tasks, but there should be a zero-tolerance policy for late or consistently inaccurate coding.
The Forgotten World of Provider Enrollment & Credentialing
Provider Enrollment & Credentialing is like the forgotten step-child of the revenue cycle. All too often, this complex task is assigned to someone with an already full plate who may or may not have the expertise needed. Assigning this to someone without the proper knowledge or time can equal a growing pile of denied claims. Outdated information, issues with payer enrollment, and incorrect facility linkage are the top 3 enrollment and credentialing-related denials. The answer here is to either find someone internally and dedicate them to just this process or if that isn’t viable, find an outsource vendor that you can trust to get the job done.
Automation is Your New Best Friend
The process complexity of the revenue cycle means manual just won’t cut it anymore. Billing automation is essential in today’s high-volume, complex billing world. From the moment a patient approaches the front desk, automated billing identifies errors before a claim is even submitted, leading to cleaner claims and faster turnaround. Medical billing software should do all the heavy lifting for you. First, however, you’ll need someone who knows how to implement that system efficiently. The goal is to reduce time spent on claims submission, not just reassign that time to figuring out the automation. To use AI to minimize denials effectively, you will need either an internal IT person dedicated to automation across all platforms or an external partner who understands your world.
Since these 4 points are outside the billing center, they are often overlooked. The next time you meet with your billing manager or revenue cycle director, take some time to dig into your denied claims and A/R to discover the root cause. We guarantee that some of these points show up. Now you will be prepared to take the next steps and drive down that denial rate!