How to Avoid Insurance Denials

Do you pay attention to the denials you receive from payors?  How do you handle them in your office?  Do you work all of them and look for patterns?  Do you appeal your denials with the payors that processed them?

This week, we want to provide some tips on avoiding the denial in the first place.  Having some solid front end procedures in place can go a long way to improving your cash flow.  Fewer denials will mean quicker payment.  And remember, it costs $6 to handle a clean claim that gets paid, and $25 to rework a claim.

Here are some things you should be sure to watch out for to mitigate the denial volume in your practice and increase your clean claim volume:

Review encounters prior to sending to insurance

Ensure that all appropriate modifiers are on the claim

Verify the patient’s insurance coverage

Verify that subscriber and patient information is correct on the claim

Ensure that you’ve covered claim-specific items, such as including the date of injury when applicable

Ensure the codes going out on the claim are consistent with patient age and demographic information

Attention to these tips will get you on your way to cleaner claims!