How to prevent denied claims

October 19, 2021
Last updated on October 19, 2021
3 min read
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Medical billing is a stressful, long process, but there’s nothing worse for billers than receiving the dreadful “claim denied” email. It’s important to accept that claim denials are part of medical billing. We can’t eliminate them for good, but there’s a lot of ways billers can work to avoid them for the most part. If your practice is still billing claims manually, you almost certainly see more claim denials than those who are working with cloud-based Medicaid billing software. However, both automated and manual billing can yield errors if you aren’t careful. If you know how to prevent denials, you’ll be in good shape to see fewer errors and keep your billing on track. 

What is a denied claim?

If your claim is denied, this means your payer has refused to pay the claim as it stands. Depending on the severity of the problem, your claim falls into one of two categories: soft denials and hard denials. A hard denial is one that can’t be corrected and therefore becomes lost revenue. A soft denial, on the other hand, is one that can be corrected and eventually paid. While denials are never good news, a soft denial is obviously the better of the two. 

How to prevent denied claims

Denied claims may sound like a scary prospect, but the truth is, there’s a number of things your billers can do to prevent them from landing in your lap. We know a lot more about the medical billing process than we did decades ago, and as such, we have the tools to prevent catastrophic denials that cost your business precious revenue. These are just some of the ways to set yourself up for better billing:

Invest in medical billing software 

If you aren’t already operating through an automated process, this is the biggest thing you can do to avoid frequent denials. Although billing systems aren’t cheap, they’re well worth the investment. Automated billing speeds up the claim process and yields far fewer errors than manual billing, which means you’re saving money almost immediately. Sit down with your team and discuss the possibility of making the investment and the advantages that come with it. 

Develop a denials task force

The best way to fix a problem is by tackling it head on. In this case, it’s a good idea to create a small team at your office responsible for analyzing denials trends and figuring out what needs to be done to get ahead of these mistakes and eventually avoid them all together. 

Gather the right patient data before every appointment 

Most errors occur before the appointment even begins. Too often, front-end staff neglect to collect the necessary information before an appointment, including both patient data and insurance information, resulting in claim errors later on. It’s crucial that every patient verify personal information and insurance coverage before every appointment—even if that patient is a returning visitor. This ensures information will be correct and present on the claim when it’s time to file. 

Work directly with payers

Make sure you’re aware of all payer requirements before submitting claims. Follow specific guidelines per payer and contact them directly to verify that you’re including all necessary information in the proper format.

Book your free BillPro demo today

You deserve better billing. The BillPro team is excited to show you how that’s possible with your free, personalized demo. Book yours today to change your billing process forever. 

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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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