Rejected Claims Hurt Revenue

In the fast paced world of medical billing, it can be difficult for your staff to keep up with not only a busy practice, patient phone calls, needs that crop up and then the medical billing too. If a member of your staff misses a line item on your medical billing or uses an out of date code, it can directly affect your revenue in the form of a claim that isn’t fully paid or worse a rejected item that requires your staff to pull the file, review the documentation and then resubmit the claim to the carrier. This takes valuable time away from your practice and has your staff chasing paperwork when they should be servicing your patients and helping your practice grow. Not to mention, you’re still not getting reimbursed for services performed until that claim is re-submitted, accepted and paid.

As stated before, in some cases the rejection will be due to your medical billing form either having incorrect coding or out of date coding. Codes and modifier requirements can change more than once a year so it is important that if you’re going to be doing the coding within your practice, that your staff remain up to date on the latest filing requirements.

In other cases, a rejected claim by a carrier is due to the pre-certification requirements not being met. Many times, procedures will need to be pre-certified by the carrier prior to services being rendered or the carrier simply will not honor the medical billing claim when it is filed. One way to cut down on your claim rejections, is to have your staff document when they call for a pre-cert when a patient needs a procedure performed.

If you find your practice no longer has time to chase the paperwork, it may be time to outsource your medical billing claims. Your medical billing partner will not only submit your claims electronically, just by having a service that can submit your properly coded claims via EMS, your rejection rates will only be about 1%-2%. Not to mention, they stay on top of your claims and can even get your practice certified with multiple carriers – this will enable you to grow your practice and realize more profit than ever before!

View all Articles by: Kathryn Etienne, CCS-P