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N2 Perfection
By The Staging Fashionista January 08, 2010
N2 Perfection is a reliable company for both painting and cleaning services. If you want friendly and professional service then N2 Perfection should be your choice. ...read more
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The Lost Revenue: Rejections and Denials
The medical billing process can be a smooth process if there were never any complications. Too bad that is not the case since there are always changes in healthcare regarding codes, processes, and payments. One of the most frustrating parts of the medical billing process seems to be insurance rejections and denials. Working rejections and denials is essential to operating and maintaining a successful practice revenue cycle because if they are not worked that is money not collected. Although no practice wants to have or deal with rejections or denials, a practice can feel the consequences of lost revenue. There are many ways to handle rejections and denials, here are a few reasons: It is important to first make sure that your billing staff understands the differences between a “rejection” and a “denial.” A rejection is created when a problem comes up before the claim is even processed by the payer. The claim is usually kicked back right after it is electronically uploaded. Rejections can be caused by things issues such as: submitting incorrect policy numbers, wrong patient birth dates, duplicate claim, patient not associated with the policy number submitted, or the claim being sent to the wrong insurance company. Denials, on the other hand, are received from the payer after a claim has already gone through the payer’s adjudication process and the payer has reviewed the claim and determined the claim will not be paid. A claim can be denied due to the services provided not being a covered benefit, claim is determined to not have been a medical necessity, or the carrier views the service provided as experimental treatment. To prevent the loss of revenue and correct the rejection and denial issues, your office staff first needs to have a clear understanding of what is required from the patient at the time of service and verify the patient’s insurance information. This is important because it will help to identify rejections before the claims are submitted to the insurance carrier. Verifying benefits can be conducted before a patient’s appointment either real-time, which is via an insurance’s website or through the clearinghouse, or the staff can contact the payer directly. Although verifying a patient’s benefits can be time-consuming, it can decrease the risk of a rejection for something as simple as a patient’s date of birth being incorrect, which can prolong the payment of a claim. Another tool to prevent loss of revenue due to denials or rejections is by fixing denials and any rejections that occur as quickly as possible because most insurance companies require claims to be submitted before a specific timely filing date. The misconception with this is that all insurance have a filing date of one year when in fact the timely filing and appeal filing limits either have changed or are changing soon for many insurance carriers. Examine your current medical billing processes and make adjustments as necessary to make sure they don’t happen again. When building or continuing to establish a practice, oftentimes things become redundant or placed on the back burner because no one wants to deal with it. Rejections and denials seem to be one of those things. It is important for rejections and denials to continuously be worked because it can become lost revenue. One motto we at Graceful Beginnings continue to push is “the objective is not just to obtain but to maintain” and the same goes with your practice. ...read more
By Practice Management Solutions, LLC March 13, 2013