7 Important Processes that Reduce Your Claim Rejections & Denials

You’ve been there before. You gather all patient information. You check their insurance details. You submit the claim hoping for a smooth reimbursement. Instead, you’re greeted by a claim rejection or an insurance denial. Now you need to start the process again.

Not only does this hurt your cash flows, but also dampens your industry track records. It’s not just you, though – nearly 50% of healthcare providers reported an increase in their claim denial rates over the past year. A good chunk of these claims are rejected due to incomplete information and data entry errors and denied for inconsistent details, billing errors, or delays.

But the interesting part is that about 90% of claim rejections and denials are preventable.


Let’s have a look at some of the best denial prevention practices you can follow to restrict your claim denials and maintain the healthy 90% first-pass acceptance rate that medical billing industry standards demand. Remember, efficient Revenue Cycle Management (RCM) processes is key to your cash flow.

7 Processes to Reduce Your Denial and Rejection Rates


1. Collect and Verify All Information

Straight from the first contact, it’s important that you gather all accurate patient information. This includes their demographics, insurance details, medical history, and more. Spend some time cross-checking all information. Ensure that patient data, including name, date of birth, and policy number, matches perfectly with the insurance records.


Another vital factor is the validity of your patient’s insurance benefits. Make sure you verify this – the insurance coverage, and their eligibility right at the beginning. Detailed notes about the patient’s insurance policy, treatment plan, and other crucial data can make the difference between an approved claim and a denied one.


2. Stay Up-to-Date with All Regulations

There are frequent updates to the coding and billing regulations in healthcare. It’s crucial that you and your staff are always on top of the latest updates on CPT, ICD-10, and major coding and billing practices. Conduct regular training sessions to keep your employees up-to-date on post-pandemic regulatory changes and compliance requirements.


In the same vein, proactively monitoring compliance issues can prevent many denials. Implement processes to track changes and ensure consistent adherence to regulations. Here, compliance software works wonders in tracking updates and addressing changes.


3. Submit Claims on Time

Whether it’s due to insufficient information, inconsistent patient communication, or a lack of resources, a delay in claims submissions is your ticket to a denial. 


A majority of the delays stem from an over-reliance on manual procedures. If your practice still relies on paper-based claim submissions, it’s time you consider an upgrade to electronic claims submissions. This method helps reduce processing time and minimizes errors associated with manual submissions.


Moreover, you need to keep track of the different payer-specific deadlines with regular alerts, ensuring timely claim submissions. When doing so, it’s a good practice to consistently monitor the billing process and address any bottlenecks that could lead to potential delays.


4. Ensure Accuracy in Billing & Coding 

Errors in billing and coding are your biggest enemy. They lead to incorrect charges, delays in reimbursement, legal issues, and increased claim denial rates. Maintaining accuracy in your billing processes is non-negotiable.


Invest in comprehensive training for both billing and coding staff to ensure their proficiency in the respective fields and their nuances. Implementing quality control measures is also a great way to catch and fix errors before they result in denials or billing discrepancies. One such measure is establishing a feedback loop where errors are reviewed and fixed on the spot to minimize mistakes.


5. Run Some Audits

Even when you follow the best practices and adhere to all regulations, you’re likely to make some errors or oversights in billing or coding. Running regular audits of your billing and coding practices helps remove such issues and create a clean slate.


It’s also crucial to review your denial reports and analyze root causes to pin down recurring issues. Once you understand the base cause of your denials, it’s simpler to implement corrective actions and enhance your overall billing accuracy.


6. Sign Contracts with Major Insurers

Your claims submissions are bound to be denied when you’re out of network with your patient’s insurance plan. Whether out of emergency, specialized care, or lack of knowledge, when a patient with an out-of-network insurance plan chooses your practice, it can lead to a huge administrative burden to wrestle with the insurance over payments.


It’s advisable to sign contracts with all the major payers in your area as an in-network provider. This ensures that your claims sail through without disruptions. Staying in-network with major insurers also helps you avoid costly denials and billing issues.


7. Consult a Professional

Managing coding and billing complexities in-house is a challenging task, and can significantly increase the insurance denial rates. It’s wise to rope in the experts. Leveraging the expertise, technology, and resources of a reputable medical billing services company helps you optimize your revenue cycle. 


Besides doing wonders for your coding and billing accuracy, it also helps you focus on delivering a quality patient experience. Here’s our handy guide to help you find the right medical billing service partner for your practice.


At Lister, our billing experts combine decades of their expertise with the industry’s best practices to optimize your revenue cycle and drive up your cash flows. With a consistent track record of a >98% first-pass acceptance rate, and < 2% in claim denials, we help you achieve maximum reimbursements faster than ever.


Key Takeaway

Claim rejections and denials can be a significant drain on your practice’s resources and profitability. The measures we discussed above will help you develop a strategic medical billing system with high accuracy, minimal denials, and a healthy cash flow. 


In the end, all you need for minimizing your claim rejections and denials is a systematic approach that emphasizes accuracy, compliance, and continuous improvement. 


At Lister, we understand the complexities of medical billing and the impact of insurance denials/ rejections on your practice. Our team of billing experts goes over and above to identify and eliminate any bottlenecks in your billing process, ensure maximum claims accuracy, and optimize your revenue cycle.


Dealing with increased denial and rejection rates? We’ve got just the fix for you. Our Free Mini-Audit helps identify your billing errors, minimize denial rates, and find ways to maximize your revenue flow. Write to us at contact@listerventures.com and claim your FREE Mini Audit today!