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Rate of Denial

Updated: Aug 1, 2023

Don't Accept a Standardized Claim Denial Rate

Insurance claim denials are something that will happen in every medical practice. The secret is to maintain an acceptable denial rate. Without giving it any thought, several practices continue to operate at a 10% denial rate over years. 10% shouldn't be seen as reasonable because it can build up to a sizable sum of money over the course of a year. Instead, a 10% denial rate needs to be handled right now and forcefully. Even with a denial rate of between 5 and 10%, which is ordinary and for some people acceptable, there is still potential for improvement.

Denials themselves are expensive since they result in immediate financial loss. Don't forget to budget for the extra time and money needed to resubmit and refile rejected claims. Denial rates of 3–5% are ideal, but getting there will require some work. We can be quick to attribute the issue to insurance firms. They are the ones returning the claims, after all. A practice can, however, take a number of steps to ensure that claims are submitted accurately and in accordance with payer criteria.

Determine the Main Grounds for Rejection

Insurance companies may reject claims for a number of reasons. Many of the factors depend on the speciality that is treated in the practice, while others can be connected to how various payers handle claim processing. Examine the list below and contrast it with the procedures used in your practice. This is a useful method for immediately spotting potential revenue cycle issues.

  • Patient's eligibility is no longer valid.

  • Particular services are not protected.

  • mistaken demographics

  • Multiple claims

  • error codes for procedures or diagnostics

  • insufficient authorisation or referral

Employ a Committed Billing Staff

You might want to think about adding more people to process the claims depending on the size of your clinic and the complexity of your billing operation. A qualified medical coder can ensure that all diagnostic and service codes are accurate on the claims, while a billing manager can oversee the entire process. These two employees are also able to evaluate claim denial trends, put together remedies, and immediately send information and references to doctors and other employees.

Verify the accuracy of claim submissions.

This one is a no-brainer. Each claim should be checked once, if feasible twice, before being submitted. A straightforward error review can readily find a simple coding or demographic issue, which will almost certainly result in a claim being rejected.

Before making any changes to the procedure, make an effort to understand why your claims were rejected. Hiring a billing provider to manage all or a portion of your revenue cycle is another strategy for the issue. Numerous billing services provided by ProMD Practice Management can lower your claim denial rate and increase your collection rate. Call us right now to learn how we can assist.

In order to maximize earnings and improve patient happiness, ProMD Practice Management is delighted to assist you with your billing assessment needs. Call 888-622-7498 to learn more about how ProMD can make your practice function like a well-oiled machine, or use our online form to ask for a billing evaluation.

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