Medical billing in denial management normally means the refusal from an insurance company to pay for the healthcare services obtained by their clients in Australia. The medical billing denials are always the problem creators for the policyholder as well as the hospital financial executives. It may affect the cash flow, operational efficiency, and authenticity of the hospitals. As per the industry benchmark, the permitted medical billing denials is 2%, but on an average, it ranges 5-10% in practice. The possible solution is reworking, and it may invite another financial burden. By executing the denial management in medical billing properly these overburdens can be avoided. The medical billers should have good knowledge of the medical billing denials and should be able to pinpoint the problems. The high probability of medical billing denials is the following.
Top 5 medical billing denials
Denials are mainly of two types- Hard denials and soft Denials. Hard denials are incorrigible and will invite huge loss whereas soft denials are temporary and the provider can correct the claim.
- Missing information
Just because of the absent-mindedness you may miss one column in the claim form and that can trigger a denial. A wrong plan code or absence of security number may cause most of the denials. Sometimes denial write-offs also may happen
- Duplicate service or claim
Some people may produce the duplicates for a single encounter without any change in date, beneficiary, provider, etc. Up to 32 % denials are in this category.
- Already adjudicated service
When the beneficiaries claim a certain service in the allowance of some other service which has already been claimed, the policy denial will happen.
- Not covered by the payer
One should be well aware of their current benefit plans in Australia. Someone may misinterpret their plans and apply for false claims. Before proceeding with the actions you should recheck the details in eligibility criteria.
- The limit for filing expired
Medical claims always will have some periodic limits. Within a certain number of days, if one fails to claim the insurance, it may be denied. This normally includes the time for rework also.
Importance of medical billing in denial management
It is always better to take preventive actions against denial of medical claims since it may slow down the cash flow and affect the revenue cycle management of Australia. Giving proper training on denial management in medical billing will reduce the denials. Make the following things as part of the denial management system.
- Categorize and quantify the denials
- Creation of task force to track the records
- Create improved patient data sheets
- Avoids incorrect assumptions and go for true reasons for denial
- Optimize the claims managing software
- Usage of automated predictive analysis to remove the possible denials
- Work with payers
To manage the denials effectively all hospitals in Australia should have enough manpower and technology. The rules and regulations of health insurance are changing frequently. So the best option is to outsource these works to experts in this field like vision-iknow.com. Dipping the backlogs they will help you by identifying the primitive cause of denial and enhance the revenue cycle system.