Denial Rates

Don’t Settle for an Average Claim Denial Rate

Every medical practice is going to experience insurance claim denials. The trick is to keep the denial rate at an acceptably low level. Some practices work for years at a 10% denial rate without giving it much thought. 10% should not be seen as acceptable as it could add up to a significant dollar amount over the course of a year. Rather, a 10% denial rate should be addressed quickly and aggressively. An average, and for some acceptable, denial rate is between 5-10%, but even that leaves room for improvement.

Denials themselves are costly because they translate directly into lost money. Don’t forget to consider the additional costs in time and resources required to resubmit and appeal denied claims. Denial rates of 3-5% are in the sweet spot, but it will take some effort to get there. We might be quick to blame insurance companies for the problem. After all, they are the ones sending the claims back. However, there is plenty that a practice can do to insure that claims are submitted free of mistakes and in accordance with payers’ requirements.

Identify the Primary Denial Reasons

There are a variety of reasons that insurance companies might deny claims. Many of the reasons are dependent on the specialty practiced at the practice while others may be tied into the way that different payers process claims. Review the list below and compare it to your practice’s processes. This is a good way to quickly identify potential problems in your revenue cycle.

• Patient’s eligibility has expired
• Specific services are not covered
• Demographic errors
• Duplicate claims
• Wrong diagnostic or procedure codes
• Missing referral or authorization

Hire a Dedicated Billing Staff

Depending on the size of your practice and the scope of your billing operation, you may want to consider hiring more staff to handle the claims. A billing manager can oversea the entire process while a certified medical coder can insure that all diagnostic and service codes are correct on the claims. These two staff members can also quickly provide information and reference to physicians and other staff members as well as review claim denial trends and implement fixes.

Check Claim Submissions for Errors

This one is common sense. Check, and if possible recheck, every claim before it goes out the door. A simple coding or demographic error is sure to get a claim denied but can easily be caught by a simple error review.

Try to get a good idea of why your claims are denied before taking any action to fix the process. Another way to approach the problem is by hiring a billing company to handle all, or a part of, your revenue cycle. ProMD Medical Billing offers a variety of billing services that can help bring your claim denial rate down and your collection rate up. Call us today to find out how we can help.

ProMD Medical Billing is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 866-960-9558 or fill out our online form to request a billing assessment.

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