Introduction
The goal of every healthcare practice is to keep their patients happy and healthy. However, in order to achieve that goal, it’s important to avoid some of the common pitfalls that can lead to medical necessity denials. One way you can avoid these denials is by putting together a solid plan for preventing them in the first place. In this blog post, we’ll cover some strategies for preventing medical necessity denials and keeping your practice’s revenue stream flowing smoothly!
Denials are inevitable.
Denials are inevitable. Even the most conscientious provider can be denied at some point, whether it’s because of an error or a misunderstanding on the part of the insurance company. But if you’re prepared to handle denials when they occur, your practice can minimize their impact on revenue and productivity.
In this article, I’ll explain why denials happen and how they can be prevented or mitigated–both before writing a claim in the first place and after receiving notification that one has been denied. I’ll also share some tips for dealing with denied claims in an efficient manner so that no time is wasted trying to get paid by an insurance company when there isn’t any chance of getting paid (or at least not enough time).
1 – Improve the documentation process.
- Improve the documentation process.
- Document thoroughly and accurately.
- Ensure that all your documentation is in compliance with state law, as well as the insurance carrier’s requirements, physician’s orders and other applicable regulations (e.g., HIPAA).
2- Have a skilled coding team.
A skilled coding team is essential to your healthcare practice. A skilled coding team can help you avoid denials and improve documentation processes, billing software, and prior authorizations.
3 – Updated billing software.
The best way to avoid denials is to make sure you’re billing correctly. If your medical billing software is outdated, it may not allow for the latest codes and modifiers that are used by insurance companies. This means that you could be missing out on potential reimbursement or even charging the wrong amount of money for services rendered.
If it’s time for an upgrade, consider these features:
- Barcode scanning capabilities – With this feature, a patient can scan their card at the beginning of an appointment and have all relevant information automatically pop up on screen so there’s no need for manual entry later on in the process
- Automatic coding updates – As mentioned above, it’s important that your software keeps up with changes in regulations so that all claims are properly processed by insurers.
4- Prior authorizations.
A prior authorization is a form that must be completed and signed by your doctor, who will then submit it to the insurance company. This process can take anywhere from one day to several weeks, depending on how quickly you and your doctor get through the paperwork.
A prior authorization should not be confused with an appeal; rather than arguing for coverage of services that have been denied by your insurance company, a prior authorization simply requires that an independent third party (the physician) determine whether or not those services are medically necessary for treatment of an illness or injury.
While there are many reasons why clients might choose not to go through this process–including time constraints on both patient and physician–there are some advantages as well: if you’re able to get a new patient prior authorization approved quickly before receiving treatment at all (or just after), then no denials will come up later when they submit their claims!
Denial prevention plan can help.
A great medical necessity denial prevention plan can help your practice prosper and avoid denials in the long run. A good plan will help you avoid denials in the long run.
When creating your own medical necessity denial prevention plan, it is important to remember that there are two types of medical necessity denials: those based on lack of documentation and those based on lack of clinical justification. Although both types may seem similar at first glance, they require different strategies for prevention.
Conclusion
Medical necessity denials are an unfortunate part of the business, but they don’t have to be a death sentence. With a little foresight and planning, you can avoid these denials in the first place. The key is knowing your patients well enough that you can anticipate what type of treatment they might need in the future–and how much it will cost.
