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3 Tips to Reduce Claim Denials

According to Experian Health, reworking a denied claim costs $25.00 each and 60% of denied claims never receive follow-up. To receive news of a denial after acquiring a client, processing client paperwork, and navigating the therapeutic relationship, all because you typed a "1" instead of a "2" can be a disappointment. You have done all the work without any of the financial reward.

Here are 3 tips that can help reduce claim denials:

1. Copy Exactly What is Listed on the Insurance Card

Attention to detail is of critical importance here. Errors can range from a name spelled incorrectly to the ID number being off by 1 value. Be sure to precisely enter what is listed on the insurance card.

Many Electronic Medical Record (EMR) softwares now allow you to save a photocopy of the patients insurance card. Keeping a copy of the patients insurance card - whether on your EMR or elsewhere - is a recommended practice that will help reduce data errors.

In addition to having a copy of the Patient's insurance card, be sure to gather the Insured's data if not the patient: - Relationship (of the patient to the Insured party)

- First Name

- Last Name

- Gender

- Date of Birth

- Current Residential Address

- Phone Number

This information can be gathered on the Patient Intake Form. More details about this document can be found below.

2. Obtain Clean Patient Demographics

One of the biggest reasons that claims get denied is due to incorrect or inaccurate demographic information. If the insurance company cannot identify who the patient is, they will not authorize payment. Having a thorough Patient Intake Form in addition to the insurance card requirement is a necessity. Many Providers use a Patient Intake Form to collect mental health data from the patient (and they should), but often times the intake form is missing the insurance and demographic information necessary for claim submission.

Here is a short list of the information that must be included on the Patient Intake Form:

- Date of Birth

- Current Residential Address

- Phone Number

- Email Address

- Gender

- Marital Status

- Employment Status

- Languages Spoken

This information and the insurance data is the minimum requirement needed to submit accurate claims. Additional information is up to the preference of the Provider, but is not necessary. Feel free to use the example Patient Intake Form. This document is specific to claim submission to better capture the needed information.

Clean patient data means information that doesn't need clarification. The amount of time spent clarifying data, waiting on a response, or resubmitting denials due to incorrectly interpreted information is astounding. Make sure patient data is legible, accurate, and up to date.

3. Outsource Billing to a Qualified Professional

Capturing the above data is a must and Providers have many tools at his or her disposal to do this with great accuracy, but claims are still going to be rejected. Unfortunately, that is a reality of any medical profession. Yet, there is still hope to reduce your frustration regarding claim rejection.

By outsourcing your billing, you are freeing yourself to focus on treatment instead of claim follow-up. Waiting on hold with an insurance company to dispute a rejected claim that seems to have accurate information is a gigantic stressor! As Billers, we understand the amount of time spent in this area and can help reduce the amount of denials. Practice Solutions, LLC believes your time is better spent with the patient than following up on claims.

Give us a call if you want to free up more of your time to focus on treatment, and less on frustrating administrative work.


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