Denied claims are frustrating for all parties involved. Moreover, denials management is time consuming, and many practices often don’t devote enough resources to pursue the maximum reimbursement. In fact, roughly 4% of all claims are denied, and it costs around $25 to resubmit a claim (Medical Group Management Association). If you or your team hasn’t properly fixed the claim or resubmitted it within the payers set timeframe, you won’t get paid. Medical billing denials management is oftentimes a tedious part of running your practice, but with Horizon Office Technologies, it doesn’t have to be.
At Horizon Office Technologies, our specialized and certified medical coding staff ensures proper coding and billing the first time, so that your claims are always submitted and coded properly and you don’t have to deal with the hassle of denied claims. Payment upon first submission is the goal, a task that requires that coding be done properly and payer contracts be consistently enforced. Denials Minimization is therefore an essential resource when it comes to effectively managing your practice’s revenue.
How to Submit a “Clean” Medical Claim
A “clean” medical claim is one that is coded and submitted properly, and in accordance with your insurance-provider contract. Clean claims ensure that you get paid on the first submission, but they also require proper data verification and documentation, as well as more than just proper medical coding.
- When a patient first walks in your door and fills out their forms, your clean claim process begins. You and your staff must be sure that you have verified all of the patient’s data, collected all insurance-provider(s) information, and registered them properly.
- Proper documentation is another vital aspect of a clean insurance claim. If your claims don’t include the proper documentation and the payer doesn’t have all of the necessary information, your claim will be denied.
- Coding is essential, but is often difficult to keep up with due to frequent changes. If something isn’t properly coded, such as using the wrong modifier or using old codes, your claim will be denied.
All information that you collect from your patients and all information about patient-visits goes into submitting a clean claim.
Horizon’s Denials Minimization Process
Don’t accept claim denials as a regular part of running your practice. Horizon Office Technologies evaluates your denied claims and implements a denials-minimization strategy to streamline your medical billing and ensure prompt payment from insurance providers. We also perform a claims-denial audit to understand why claims are being denied, and ensure that we implement the strategy and training that will work best for your office.
When Horizon joins your team, we will review all of your codes and claims to understand why your claims have been denied, and then use our specialized knowledge to identify common causes for each denial, so that we can avoid them in the future. Our specialized medical billing and coding experts know exactly what goes into a clean claim, and will offer all the necessary training and support to your staff so that we have every bit of information needed to ensure you get paid.
Our denials minimization service is an essential part of our specialized medical billing services, and our strategy is predicated upon always getting clean claims submitted the very first time.
- Proper demographic data-verification
- Enforce payer contracts
- Meet deadlines
- Ensure proper documentation and coding
- Contact your patients to let them know why the claim is denied
Don’t settle for denied claims and the hassle of constantly reviewing and resubmitting them. Horizon Office Technologies will submit clean claims for you the first time, every time. Call us today at (224) 238-4200 or complete our secure information form to schedule your complimentary consultation.