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  • Writer's pictureRMK HOLDINGS INC.

How to Identify Causes of Denied Claims

Updated: Sep 29, 2022

According to industry statistics, about 200 million health claims are denied every year in the United States. With such staggering numbers, it is therefore important for your healthcare practice to not only track the major reasons for these denials but also take steps to prevent subsequent occurrences. Here are key areas to identify and reduce denied claims.

Employ Proactive Strategies

The first step to preventing denied claims and improving revenue cycle workflows for your health services group is to employ a proactive approach rather than a reactive one. A proactive approach to this problem involves preventing denied claims from occurring in the first place by determining their root causes and taking action. Also, feedback should be actively gathered from management teams, so that areas that need improvement or adjustment can be identified then improved.

Focus on the Front End

Many denied claims are usually as a result of front-end mistakes or oversights such as errors in patient registration, insufficient front desk training, technical errors, and so on. When the front end details and attention are lacking, errors increase causing claims to be denied and revenue to be delayed. A way to prevent front-end mistakes is by cross training, continual education and implementing automatic edits within your practice management and scheduling systems.

Embrace Analytics and Technology Systems

Manual processes for inputting and managing patient information are very defective and lead to errors. For this reason alone, it is best to learn and utilize the analytics and technology systems at your disposal. Your vendor may have add on components to enable you to do more with less to manage your medical practice's patient information. By so doing, incidences of denied claims will be reduced, which will not only seek to boost the efficiency of your healthcare business but also maximize revenue.

Denied claims do not simply occur out of thin air. Most times, there are several preventable factors which cause them. The trick is identifying and then developing a process for reduction. Monitor and repeat. Begin with implementing and following these basic principles to move your bottom line results forward while leaving your patients with better billing experiences.


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