Medical insurance denials are on the rise, notably for increasingly higher-cost services. In fact, one recent analysis found that the average denial was linked to charges of at least $14,000. For many oncology practices, denials of this magnitude can be financially devastating; however, there are ways to avoid them.
“In my experience, as much as 90% of front-end denials can be remedied by identifying and addressing procedural gaps in the day-to-day office workflow,” said Tressa Harley, the founder of MD Office Insights, a payer relations strategy firm. “And about 10% can be attributed to errors on the plan’s side, where the claims processing system doesn’t properly capture relevant information on the claim.”
The good news is that many of these issues can be resolved, either proactively or after the practice receives the denial. Consider the following three tips to help head off or appeal costly denials.
Tip 1: Prevention Is the First Step
Not every claim denial occurs because of errors on the payer’s side. In some cases, the practice makes preventable mistakes. The first step in developing a strong denial management process involves putting in the work before submitting claims, to improve the odds of approval.
“To begin addressing the procedural gaps, confirm benefits, benefit limits, financial responsibility, authorization, and referral requirements priorto the patient’s visit,” Harley said. “Routinely audit claims submissions for accuracy and conduct a quarterly review of your chargemaster or claims management software for edits or updates.” These simple steps can help prevent denials before they happen.