How to handle medical billing denials

December 27, 2021
Last updated on December 27, 2021
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Medical billers work hard every day to make sure the claims they submit are error-free. This is achieved through a thorough knowledge of the medical billing process, experience in the industry, and the help of reliable medical billing software. But even in the best of circumstances, errors are possible. Unfortunately, this means denied claims are also a possibility every time a biller sits down to file a claim. This shouldn’t deter billers from doing the best they can to prevent that outcome, though. It’s important to accept that while frustrating, it’s going to happen. Equipping your team with the knowledge of how to handle denials is the best way to overcome the inevitable. 

Review all claim details 

The first step of handling a denial is to make sure you understand why the claim was denied. The denial should come with an explanation specifying the reason it wasn’t accepted and what documents are required to resubmit or file an appeal. Depending on the nature of the claim, this could be a quick fix or another long process. If you’re unsure whether the claim should actually be denied, or the denial doesn’t have clear instructions listed, you should contact the insurance company as soon as possible to clarify the situation. 

Be persistent 

The truth is, dealing with denials can be tricky. Your resubmitted claim could once again be denied, but if you truly believe the denial was in error, or you’ve corrected the problem but still aren’t seeing the right results, don’t give up right away. Familiarize yourself with the carrier’s appeal process and guidelines, and make sure you have all the information you need to succeed. When you submit your appeal, include an explanation of why you’re submitting it, any required documents per insurance guidelines, and copies of any prior communication you’ve had with the company. You may have to resubmit a claim multiple times before it’s approved, but it shows the insurance company that you’re serious about fixing the problem, and it will be well worth it when you get the money you’re owed. 

Address the problem as soon as possible

It’s easy to push your denials off when you first receive them, but this is one of the worst things you can do. Each claim has a deadline that must be adhered to, and the longer you wait, the less time you’ll have to gather all the information needed to resubmit. If you don’t resubmit your claim by the deadline, you run the risk of losing out on your payment altogether. Insurance companies are willing to talk when resubmissions are sent in a timely manner, but they’re pretty unforgiving if you resubmit after the deadline. Keep a list of your deadlines where you can easily view them to ensure you stay on track. 

Understand the appeals process

Each insurance company’s appeals process is going to be a little different than the last. The best way to stay on top of this information is by keeping record. If you work with a handful of specific payers often, stay updated on their policies and appeal processes, so if you find yourself facing a denial, you know exactly how to handle it. 

Keep records throughout the dispute process

When you call the insurance company to discuss a claim, you may talk to multiple different people during a handful of different phone calls. Communication can easily become convoluted with so many people involved, so it’s important to keep record of the exchange you have with each person. Keep this information somewhere safe, along with information about the claim, why it was denied, and how you’re fixing the denial. If your claim appeal has to be taken to a higher legal level, records will be necessary in arguing your case. 

Work together with your team

Claim denials are frustrating, but you aren’t alone in them. Every medical biller has experienced denied claims before, so remember that you aren’t in a unique situation. Work with your team to determine the best course of action, and develop a standard procedure so that when you end up in these situations, you know exactly how to tackle them. 

Stay up-to-date on payer policies 

Sometimes denials are out of your control, but there are a variety of things you can do to reduce the chance of them. Staying up-to-date on payer policies, asking questions about updates, and generally keeping a good working relationship with insurance companies is going to put you in a good position to avoid denials. 

Invest in the right software 

Denials may be a part of medical billing, but they’re far less likely to occur when you’re using reliable medical billing software to get the job done. If you’re looking for a system to change the way you bill and you’re operating in New York State, get in touch with the experts at BillPro. We offer free demos of our NYS Medicaid billing software to show you our software in action and let you ask any questions you may have. We look forward to hearing from you! 

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About the author

Emmy Kolbe is a copywriter at NY BillPro, where she spends her days writing about Medicaid billing software solutions and NEMT industry. She creates content for both emerging and existing transportation companies. She has a bachelor’s degree in journalism and mass communication from St. Bonaventure University. 

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