When was the last time you reviewed your accounts receivable? Are you tracking claims that are 90 to 120 days overdue? Regularly discussing claim performance with your billing team is essential to improving your revenue cycle and cash flow.
Your practice may lose revenue if you’re not hands-on with your billing process. Fortunately, there are proven ways to reduce denial rates in medical billing, especially for specialty practices.
The Hidden Cost of Medical Claim Denials
Understanding the difference between denied and rejected claims is the first step:
- Rejected claims: These are never processed and can be corrected and resubmitted.
- Denied claims: These are processed and returned with a decision, requiring appeals and additional follow-up.
Denied claims often delay payments, commonly pushing reimbursement to 90 or even 120 days. These delays directly impact your practice’s cash flow and financial health.
Why Medical Claims Are Denied
You can’t fix a problem you haven’t identified. You need to know why they’re happening to take control of claim denials. Data from recent industry reports shows denial rates have increased in the last two years. The top reasons include:
- Missing or inaccurate patient data
- Lack of prior authorizations
- Coding and documentation errors
- Staff shortages and inadequate training
- Late claim submissions
- Evolving payer policy requirements
Without root cause analysis, denial trends will continue. Often, denials are preventable with proper training, better front-desk workflows, and improved documentation.
How to Identify the Cause of High Denial Rates
Due to complex procedures and payer rules, specialty practices may experience higher-than-average denial rates. Review payer adjustment codes to determine why your claims are being denied.
Common denial reasons include:
- Invalid or incorrect procedure or diagnostic codes
- Claims submitted after the filing deadlines
- Missing documentation or insufficient clinical justification
- Duplicate billing or billing for unnecessary services
Once you’ve identified patterns, you can proactively resolve the issues, whether by retraining staff, updating processes, or improving documentation.
Solutions to Reduce Claim Denials and Improve Cash Flow
Here are actionable steps to help your specialty practice reduce denial rates:
1. Invest in Medical Billing Software
If you’re still relying on a manual system, switching to practice management software can streamline key processes like:
- Appointment scheduling
- Patient check-in/check-out
- Insurance verification
- Documentation tracking
- Automated billing workflows
Software can reduce common human errors and help staff follow claim submission timelines more accurately.
2. Partner with an Expert Medical Billing Company
For complex specialties like Oncology, Infectious Disease, Rheumatology, outsourcing billing to a professional service like Newland Medical Billing and Management can significantly impact.
These specialties face:
- Complex coding requirements
- Frequent prior authorization needs
- Strict payer compliance
- High documentation standards
An experienced RCM partner can navigate these challenges efficiently, reduce denials, and increase reimbursement rates. They’ll also free up your internal staff to focus on patient care instead of backend billing issues.
Choosing What’s Best for Your Practice
Improving revenue cycle management requires strategic planning. Whether you optimize in-house processes or outsource to a billing company, make sure you:
- Understand where denials originate
- Educate your staff
- Invest in automation
- Track denial rates regularly
- Address inefficiencies proactively
Ready to Reduce Claim Denials? Contact Newland Medical Billing and Management
If you’re ready to reduce denials, boost cash flow, and improve operational efficiency, consider outsourcing your medical billing.
Contact Newland Medical Billing and Management at 947-210-5612 today to learn how our billing experts can help your specialty practice succeed by minimizing claim denials and maximizing your revenue.
Sources:
Understanding healthcare claim denials: reasons & solutions – Healthcare Blog
Providers say claims denials are increasing: survey | Healthcare Dive
Rejected or denied? 4 questions for improved clean claims | Greenway Health
Why Your Claims Are Getting Denied—and What to Do About It – Oncology Practice Management
