How to Prevent Medical Billing Claim Denials
                     How to Prevent Medical 
Billing Claim Denials?
www.mgsionline.com
 While ensuring efficient patient care, Providers and healthcare practices work 
24/7 to improve their billing performance and revenue. 
 However, the introduction of new medical reforms in the US healthcare industry 
have complicated their goals. 
 New coding techniques and insufficient training contributed to more claim 
denials. 
 It is estimated by the Medical Group Management Association (MGMA) that 
even the exceptionally performing medical practices end up with 4% claim 
denials. 
 Then imagine the claim denial rate of developing healthcare practices. 
 It is also estimated that almost 65% of claim denials are never 
corrected and refiled. 
 Even if healthcare practices take initiative and correct the denied 
claims, they don’t submit before the time frame of 90 days. 
 All these factors affected many healthcare practices’ revenue cycle 
badly. 
 In this article let’s see how we can prevent medical billing claim denials 
and improve cash flow through efficient denial management
Analyze and Determine 
the Cause
 Avoiding claim denials involves a series of 
steps and the first one is to analyze and 
determine what causes claim denials in 
the first place. 
 Right from the frond-end to back-end 
services, there are several operations, 
which if not carried out properly can 
resort to claim denials. They are as 
follows,
Patient Registration
 This is the very first step when a patient visits a 
healthcare practice and if it is not shown proper care, 
then there can be a huge amount of claim denials. 
 Front-office staff should make sure that they register 
the patient details accurately while verifying their 
insurance benefits and eligibility.
01
02 Coding:
 Accuracy in diagnosis and procedure codes is 
crucial to proper denial management. Carrying 
out the wrong diagnosis or coding incorrectly can 
result in a lot of claim denials. 
 It is for this purpose that healthcare practices 
should offer enough training to their staff to carry 
out unsurpassed medical billing functions as per 
the new coding techniques.
Billing
 Sometimes, staff submit duplicate 03
claims meaning they file a claim for a 
service more than once. 
 Such internal mistakes are perfectly 
avoidable and the denial 
management team should check 
twice before the claims are filed.
Filing
 Claims have a certain time limit before 
which they have to be filed. 
 The time limit varies from payer to 
payer.
 Insurance companies will deny the 
claims simply if they are filed beyond 
this time limit.
04
Payer:
 After analyzing all the factors, if there 05
are no mistakes from the Providers’ 
end, then the denial management team 
must look into the Payer. 
 Sometimes, payers make errors while 
processing the claims. 
 If so, then call the respective insurance 
company and address the issue.
Prioritize
06  Once Providers fix the root cause of their 
claim denials, they should set up a good 
denial management team. 
 The team will further analyze which factors 
cause the highest impact and prioritize.
  The causes are then eradicated one by one 
in the order of the prioritization
Claims Management Software
 Yet another important step in managing 07
claim denials is setting up a proper claims 
management software in to your system. 
 The denial management team should use 
data analytics and study the pattern of 
claim denials to optimize the software and 
offer great solutions. 
 This enables healthcare practices avoid 
claim denials in the future.
About MGSI:
 All the aforementioned steps can be done proficiently by a reputed 
medical billing company. 
 Therefore, partnering with one will save ample costs for healthcare 
practices. 
 If you are looking for a highly-experienced organization then look no 
further than MGSI, a one-stop-shop to all your medical billing needs. 
 This Florida-based company has more than 20 years of experience 
providing exceptional denial management services to its clients. 
 To learn more details, log on to www.mgsionline.com.
Thanks!
Does anyone any questions?
Mail us: [email protected]
Call us: +1 813 666 0028
Website: www.mgsionlne.com
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