3 Ways to Prevent Denials

When maintaining a healthy practice, it’s imperative to keep abreast of the inner workings of your office to ensure it’s running at optimum speed. One area that many providers lose consistent revenue is in their denials. Unfortunately, once a claim has been denied it only has a 35% chance of being reworked to recapture the reimbursement1, so having an actionable set of steps to help prevent denials from happening is imperative to running a healthy business.

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Preventing denials is a two-part system that works hand in hand – your front of house intake and your back of house billing. When you have knowledgeable and informative staff that manages your co-pays, insurance eligibility, and patient demographics it ensures the correct information is in your back of house billing system to run a claim through successfully. As a vitally important part of your practice, what are some steps your office managers and front of house intake specialists can take to make sure you don’t have money walking out the door?

  • 1. Be vigilant about clean registrations

What does this mean? It means that as a business owner you must empower your staff to make corrections and ask more than “Has anything changed in your insurance since the last time we saw you?” When your employees are knowledgeable about the full life cycle of a claim and all of the information that is needed to process a claim successfully it helps your entire staff take ownership of their piece of the puzzle.

Engaged and active employees also create satisfied patients who are confident in the office they have chosen to do business with. 

  • 2. Check Eligibility

It’s also essential to ensure the clinician providing care is contracted and credentialed with the exact insurance product the patient is covered by. “Most practices don’t even know precisely who they’re contracted with,” Penny Noyes, president and CEO of Health Business Navigators says. “They’re pretty confident they’re with the Blues, Aetna, et cetera, but they don’t know for sure if they’re in the HMO, PPO, Medicare Advantage, or private Medicaid products.”

Noyes recommends practices conduct a periodic review to confirm which products each clinician in the practice is linked to. It’s time well spent, regardless of how long it takes. In a small practice, this information can be gathered through one or two phone calls to each payer, she says.

Considering that 90 percent of denials are preventable, most practices can become top performers — not just for bragging rights, but also for the opportunity to gain significant revenue and increase their bottom line while reducing their bad debt.

  • 3. Ascertain Financial Responsibility

One of the most important tools you can arm your front of the house staff with is a prequalification and estimation tool. When you give your patients an estimate of what their treatment will cost it gives them the ability to plan and budget for the expense.  It also increases your patient-practice loyalty because not only are you keeping your own bottom line in check, you show care and concern about your patient’s well-being outside the confines of your office.

In tandem with a prequalification and estimation tool, giving your patients the ability to pay over time gives them more control over their finances and lowers the chance of your patients not paying their bill at all. Through our HonorCare program we have found that giving patients a payment that works on their timeline and within their budget increases the practice’s likelihood of being paid. While it may take longer for your patients to reach a zero balance, bringing some money in over a long period of time is better than not getting any money at all and having to write that patient bill off to bad debt.

Week after week we see healthcare facilities closing their doors or opening themselves up to a corporate buyout due to bad debt or outdated practices. Maintaining a healthy revenue cycle is vital to a growing and expanding healthcare organization, as well as ensuring your patients are satisfied. The key is to be knowledgeable as to what your company needs, what your patients desire, and how your staff is handling the inner workings of your practice. If you take the time to find out what tools could help your staff do their job with increased productivity, you could help your practice become more profitable.

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