Insurance companies issue denials for a number of reasons. Many of these denials do not indicate that the claim cannot be paid, only that the claim requires additional or corrected information before it can be processed. For example:
- Invalid Subscriber ID
- Medical Necessity
- Invalid Diagnosis Code
The key here is to post your denials into your practice management system. This allows your denials to be tracked and worked at a later date. Of course this does mean the denials need to already be set up in your practice management system, but we’ll cover that later under File Maintenance.
Tracking denials is the next step to improving your revenue cycle. Now that your denials are posted in your system, you should can run a report that will allow you to discover your top denial types. This is important for several reasons. Most importantly, it pinpoints where there may be gaps in your workflow. If you have a high number of eligibility denials, you need to make sure the front desk knows how to check eligibility OR make sure your electronic eligibility system is functioning properly. Eligibility should be done two to three days prior to the patient’s appointment to allow time to investigate any discrepancies before the patient walks in the door.
File maintenance plays a huge role in tracking your denials. Most practice management systems have a transaction or adjustment type you can customize. This is where you enter in your denial types to be able to start tracking your denials. Start with the most common – you can always add more later! Some systems come pre-loaded with the standard CARC (Claim Adjustment Reason Code) and RARC (Remittance Advice Remark Code) codes.
However, denial types are not the only reason you need to consider regular file maintenance. If your practice can add insurances on the fly, this probably means you have several, if not dozens of duplicate insurance companies loaded. This makes reporting and identifying payor issues more difficult.
Or perhaps you are receiving a lot of denials for invalid NPI number for one of your providers. This could be a larger credentialing issue, or simply means you need to ensure the provider’s NPI is correct in your billing system.
Working your denials timely and regularly tells the story of where your practice needs some fine tuning. Ignoring these can lead to lost revenue due to lack of follow up.