Most of the providers don’t know about the total number of claims denied in the first phase. This is among the primary topics surveyed & discussed, and providers are stunned by finding the cumulative percentage of revenue lost due to those initial denials. The need for medical documentation and the absence of authorizations are the most well-known reasons for claims denials Insurance Eligibility Verification services permit to check the coverage and benefit details there by reducing the denial percentage of the practice.
Increasing efficiency and improving billing collection rates should be the foremost concern for healthcare providers with focus on availing required prior authorizations and eligibility verification done before the service is rendered. Claim denials are the refusal of an insurance agency to respect a solicitation by a provider/person to pay for healthcare services got from the healthcare professionals. The expenses related to not following up on the claim denials can affect the businesses and cause inefficiencies within a provider’s claims management and revenue cycle.
Regular denial management audit helps you to identify the claim denials reasons, Such as
- Duplicate claim submission
- Service previously adjudicated
- Services not covered by the payer
- Time limit for claim submission expired
- Insufficient medical necessity
Here a few claim denial reasons are discussed in detail:
Insufficient Medical Necessity
This can be a challenging situation for all parties, yet you might have the option to avoid them. Regardless of where medical necessity isn’t obvious good communication among patients and providers is important to make the best decision on medical necessity. At the point when a claim is denied because of medical necessity, your practice could be compelled to either assimilate the expense of services or endeavor to gather the whole payment from the patient neither of which are acceptable alternatives.
Time Limit For Claim Submission Expired
One significant issue medical billers experience is when claims are denied for the timely filling because each insurance carrier has various rules and regulations for claim resubmission. So it is a difficult task for physicians and billing team to keep up with the various timelines with each payor. To avoid this kind of issue outsource your medical billing to the best medical billing company that specializes in denial management and AR follow-ups.
Claims are frequently denied for timely filling even when the claim submitted on time however not got by the insurance carrier. There are numerous reasons this can occurs, yet the significant aspect of the condition is how the biller responds to the denials.
Other times, claims are denied for timely filing when they were not submitted within the filing time frame because of initial errors.
About MGSI
MGSI is the best choice for medical billing outsourcing in Florida, US. We provide various services such as anesthesia billing, cardiology billing, insurance eligibility verification services, etc. MGSI enables healthcare organizations and enhances the revenue cycle to improve the quality of claims and decrease denials rate and claim rejection. To learn more about how we can help, log onto our website: www.mgsionline.com