medical practice in usa

Steps to Prevent and Manage Denials That Your Medical Practice Encounters

medical practice in usa

Nowadays, it is observed that medical practices are affected by the changes in the healthcare industry and its various trends. For this reason, the health authority has modified the policies and submission requirements for claims. Also, this has heightened the importance of accurate billing. Due to these issues, medical practices are striving to perk up their revenue cycles.

But if things are properly checked and steps are taken at the right time, it will not be a big problem. Consequently, we have come up with some ways and steps that will help you in preventing and managing denials encountered by your medical practices.

Step # 1: Coordinate with the Staff

Office staff on different levels always has issues to talk about. But at times they are not given the chance to discuss their concerns which may be one of the reasons for denials. Consequently, holding monthly meetings with the billers, clinicians, and other staff members to discuss about the coding and billing issues, can save you from this. Workflow Management Optimization, Inc. suggests its clients to give regular feedback to clinicians about the reasons for denials. They need to learn how to capture all the important charges to support optimal billing.

Step # 2: Claims Need to be Filed on Time

Often it is seen that claims to the payer are not filed within the specific or designated time frame. This is one of the reasons that the claim gets rejected. The limit to file the claim is short, i.e. 3 months maximum from the date of service. In order to prevent this and manage your denials, Workflow Management Optimization, Inc. advises its health care providers to keep a list of filing windows for every payer. Also, they should track and document the claim submissions and the receipt of every claim.

Step # 3: Action Plan to Resolve Denials

Despite the best efforts you may have in place for preventing denials, they will still be denied. When this happens, you need not worry. You have to create an action plan to resolve your denials. At times, you may find it difficult, which is why you should consider hiring a credible consultant or firm, such as Workflow Management and Optimization, Inc.

They help you at every step and direct you towards the right decisions. They have automations to route denials to your staff members. Also, they use software to sort out the denials on purpose, so that your staff is able to work more efficiently. In order to keep a check, they maintain a checklist to take the appropriate measures and avoid the ones which are not required.

Prior to taking the specified steps, you first need to understand why your claims are denied. They may be denied due to data entry errors, ineligibility and non-covered services, coding errors and missing authorization. Workflow Management Optimization, Inc. has seasoned pros who know how to tackle and manage denials effectively. You can visit our website and or call us at (+1) 888-678-6284 for more information and details.