Aug 25, 2022

Strategies to Avoid Common Medical Claim Denial Errors

Receiving timely reimbursements is crucial to keeping your practice up and running smoothly. These funds are required to pay your staff, buy hospital supplies and to treat patients. For these reasons and more, claim denials can be frustrating for any medical practice, particularly the small and independent practices as they operate on smaller budgets. According to The Center for Medicare and Medicaid Services, denials can make up to 30% or more of a medical practice’s billing. We at Scribe4Me follow a set of strategies to eliminate the most common denial reasons helping you save time and improve your revenue collection.

Let us in this blog discuss some of the common medical claim errors and what best practices we at Scribe4Me follow to eliminate them to help you get reimbursed for your medical services in a timely manner.

Verify Patient Insurance Eligibility

Problem: Claims often get denied if the patient’s insurance does not cover the medical service that you have provided. Such instances can happen if the policy gets expired or if any policy updates have been made to the patient’s insurance plan.

Scribe4Me strategy: To avoid such situations it is crucial to verify insurance eligibility prior to treating a patient. For this purpose, we offer quick and efficient verification services. We get in touch with the insurance provider either through their online portal or over the phone to check if the patients’ insurance plan is currently active and covers the services to be provided. We also update the medical billing system with the insurance verification details.

Avoid Duplicate Billing

Problem: Duplicate billing is yet another reason for claim denials. A patient is sometimes mistakenly billed twice for the same test, exam, procedure, or treatment. This can happen if the billing staff fails to check if the patient has already paid for the service provided.

Scribe4Me strategy: Duplicate billing is a source of unnecessary expense. Our experienced billing experts are skilled and vetted professionals who do their job well. We also have quality checks at every step to review your files before submission. This helps to avoid delays/ loss of payments loss of reputation and fraudulent investigations.

Use Correct Codes

Problem: The use of outdated codes or incorrect codes is yet another reason for claim denials. This can happen due to lack of knowledge or negligence. In either case it can result in claim denials.

Scribe4Me strategy: We have a team of experienced billing staff who receive appropriate training in coding and stay current with the coding updates to avoid committing such errors. Our coders are also provided with the latest coding reference manual. This can result in a more streamlined processing of claims, reduced rejected or denied claims, and improved cash flow.

Check for data-entry errors

Problem: Sometimes even simple typos that you didn’t catch it until the claims were submitted can result in denials. Clerical errors due to sheer negligence like entering the incorrect insurance policy number, or insurance company or patient data, or provider details can result in your claim being denied.

Scribe4Me strategy: We proofread and double-check to ensure that all information entered is accurate before submitting a claim. We know that even simple typos like patient names misspelled or digits in the policy number being transposed can be grounds for claim denials.

Manage Payer Mistakes

Problem: You have done everything right from your side, but still your claim gets denied or rejected. Wondering why? Payers can also make mistakes like providers. If you have reviewed the accuracy of coding, data entry and documentation then there is a possibility that the insurance company has processed your claims inaccurately.

Scribe4Me strategy: We call the insurance provider to figure out the reason for the denial or if we have other questions about it. If we feel that the claim has been incorrectly processed we request for reconsideration or file a written appeal. Our denial management experts keep track of repeated denials to find out what the reasons might be in each specific case.

The Upshot

It is quite shocking to note that 4 out of 5 medical bills contain errors. Are you worried and wondering how to avoid medical claim errors? Breathe easy. Our medical billing experts have the expertise in processing your claims accurately and help prevent claim denials and the headaches that go with it. By outsourcing your medical billing needs to Scribe4Me you can avoid errors in claims and improve your overall reimbursements and keep cash coming in.