Reducing claim denials for practices and medical groups
Reducing Claim Denials

You can't totally eliminate denials, but you can reduce them

Seventy-eight percent of physician practices participate in some form of value-based payment models, and most expect their participation to increase in the coming years.

While you will never completely eliminate denials, there are some things you can do at the front of the revenue cycle to make them less common. First, make sure all patient demographic data is current. A misspelled name, a transposed digit on a social security number, or an incorrect date of birth can all cause a payer to deny a claim. Second, make sure your staff is validating insurance coverage. You don’t want to find out after the fact that the coverage was expired, that a referral was required, or that the procedure wasn’t covered. Third is to determine whether the procedure requires pre-authorization. Health plans are increasing the number of procedures and treatments that require pre-certification or pre-authorization. As a result, many practices are seeing an uptick in denials related to this.    

Denied claims are a fact of life, but you can takes steps to improve denial management.