Are you wondering how to properly handle your claim denials? Check out this complete guide to proper medical claim denials management.

Did you know that medical claim denial rates have risen 11% across the US since the pandemic first began? More importantly, most of these claim denials were due to data entry errors and insurance coverage problems.

If you're experiencing issues with medical claim denials, knowing where to begin to fix this process can be overwhelming. You need to take a step back to identify the problems, but you'll need to know what to focus on first.

To learn more, keep reading this guide to see how to effectively deal with medical claim denials so you can get back on track!

Identify the Problem

The first step in claim denial management is identifying the key problems. This is also the best way to prevent them from happening again. It's essential to be aware of the most common reasons for claim denial, which include:

Submitting claims and initial rejections past the insurance company's claim deadline

Submitting claims that aren't covered by the patient's insurance plan

Not getting proper prior authorization before services are completed

Claims that have missing or incorrect patient information

Duplicate claims submitted for the same service

The provider is out of network

The insurance company deems the service not medically necessary

Medical coding mistakes like using the wrong code for a service

Finally, bundled medical codes are one of the biggest issues that can cause medical claim denial. With bundling, certain services must always go together; therefore, they are always billed together.

Claim denials mainly occur when you don't bundle the correct services together or try to bill certain services separately.

Medical Claim Denial Solutions

Next, you'll need to be proactive and act quickly when you receive a claim denial. You'll need to form a denial management plan so you know what to focus on first. You can start this process by taking steps that include:

Create a Task Force

To analyze the denial trends and determine a timeline to deal with claim denials, you'll need to choose key staff members from each department. They'll need to contact insurance companies, talk with staff, and pinpoint claim format issues.

Improve Patient Data Entry Quality

Next, you'll need to focus on the patient data that's entered at the time of registration. It's important to narrow down the source of where the errors are coming from and make plans to improve this process.

You'll need to provide staff training on data entry, insurance verifications, and claim deadlines. You'll also need to conduct frequent performance audits to ensure compliance.

Outsource Your Medical Billing and Coding

One of the best medical claim solutions is outsourcing your billing and coding, which puts your entire denial management plan into place in one step.

You won't have to worry about re-training staff, hiring new billing or coding staff, or dealing with claim denials.

You'll also save money long-term as professional billing, and coding companies offer you expert billing and coding services at a reasonable cost. Along with claim denial management, these companies also take care of a variety of processes, such as:

Insurance verification and preauthorization

Medical coding with accurate diagnostic and treatment codes

Enter charges for services performed for all your patients

Submit all your medical claims

Insurance payment