Every practice works hard to appeal claim denials and overturn them to get back the reimbursement they’re due. But what if you could spend less time on appeals by preventing medical claim denials before they happen?
In some cases, you probably can. Check out three strategies to halt medical claim denials so you can collect more.
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Stop Sending Duplicate Claims
CGS Medicare, a Part B Medicare administrative contractor (MAC) says duplicate service submissions are the number one cause of medical claim denials, responsible for nearly 22,000 denied claims last year.
To prevent duplicate claims, you should check the status of all of your claims before resubmitting a new one to the payer. If you get a denial, file an appeal rather than simply resubmitting the claim and hoping for the best.
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Check What Your Provider Is Licensed to Do
CGS processed over 3,000 denials for claims that providers weren’t licensed to perform. Remember that state scope-of-practice rules dictate which services certain providers can perform, order and refer. If you don’t have this information at your fingertips, it’s time to get ahold of it.
For example, your registered nurse may be eligible to perform immunization injections but not Botox injections, while your nurse practitioner may be eligible to perform both. Always confirm before performing these services and billing them to your payer.
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Confirm Which Payer is Primary
More than 6,000 denials happen every year at CGS Medicare because the wrong payer was billed first. Remember that if Medicare is the secondary payer (referred to as “MSP”), the primary payer has to be billed first or you can’t bill Medicare yet.
Other payers that you may not always think about, such as workers’ compensation insurers for work-related issues or auto insurers for accidents, may also need to be billed first. Keep a list showing payer hierarchy at your practice so you always bill the right payer first and avoid these common denials.
| Your Claim denials are on the rise and you don’t want to be a statistic. Let experts Alexis Armstrong and Cindy Groux, CPC, help you avoid denials during their online training, Simple Strategies to Prevent Claim Denials and Get Paid More. Sign up today! |