Denial Management
1.Denial rates vary widely depending on physician specialty. Denials for some specialties, such as obstetrics and gynecology, can be as high as 20 percent. Denials for primary care practices can be 10 percent or below. As a rule of thumb, a denial rate of 15 percent affects practice profitability.
2. Obtaining an accurate reflection of denials for a multispecialty practice can be challenging. “The denial rate for a multispecialty group practice may be 5 percent, but that overall rate may include a 20 percent denial rate for obstetrics and a rate of 1 percent for family practice. You need to look at denial rates by type of specialty. We segregate denial rates for primary care [family practice and internal medicine]from those for specialties that have potentially higher denial rates.
3.When the denial rate is high, it should be looked at immediately. We address two areas of denials: why they are occurring and preventing them in the first place.
At Global Billing Coding Denial Management is not introduced to just resubmitting a claim. We have a team of experts who analyze the reason for denial, track the most common denominators and systematically work on identifying and eliminating weak links. Our collections and denial management support helped practices reduce claims rejection drastically.
Information verification before the bill goes out the door:
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The most common reason for denials is incorrect information: ID numbers are incorrect, CPT codes or modifiers are not put in the right place, names are spelled incorrectly, or names don’t match what is printed on the patient’s insurance card.
2. We make sure to verify all these details before claims are sent out.