Top 11 ways physicians can fight back against denials
Seventy-five percent of physicians say frequent payer denials are an ongoing problem at their practices, according to the Medical Economics Payer Scorecard. Rejected claims are clearly a source of frustration, but is there anything physicians can do about them?
Yes, experts say. Consider these strategies to better handle denials.
Don’t “deny” the denials
Many physicians incorrectly assume that they’re not experiencing denials simply because cash is flowing into the practice, says consultant Elizabeth W. Woodcock, MBA, CPC.
This is rarely the case, Woodcock says, adding that a 5% denial rate is average, and anything above that should be cause for concern.
Dig into the data
Identify the root causes of the denials, and take steps to address those causes, says Maureen Clancy, MBA, FACHE, CPC, senior vice president of revenue cycle management and credentialing at Privia Health, a physician practice management and population health technology company.
This is especially important in the case of denials stemming from incorrect patient information. “Otherwise, what happens is that the billers keep fixing the [registration-related] errors, the front-end keeps making the errors and the loop continues,” Clancy says.
Pre-registration is one solution. Another is to make time for validating patient information, she says.
Pay attention to the patient’s specific health plan, says Raemarie Jimenez, CPC, vice president of membership and certification at the AAPC, an organization representing medical coders. A physician might have a contract with a particular insurer, for example, but it might not be the specific plan covering the patient.
“Verification of insurance is so important—not just the first time the patient comes in, but each and every time,” she says.