Medical practices are faced with several challenges and responsibilities. In addition to fulfilling their commitment to providing quality patient care, medical practices must also operate within various regulatory frameworks, and pay for necessary equipment and services. Medical practices must also do their best to avoid medical denials.
Keep reading to learn how medical practices can avoid denials.
1. Quantify and Categorize Denials
When medical practices look at the number of denials they receive and assess the sources, it is apparent that some are common across all practices. Most Medicare claims, for example, are denied because of failure to meet a required element of the chart review or failure to provide services according to an accepted standard of care. Other common denials can be traced to non-compliance with physician credentialing requirements from health insurers.
2. Improve Patient Data Quality
Most denials are based on the quality of medical records. Medical practices can reduce their denials by ensuring that all required elements are included in medical record documentation. This has both the quantity and specificity of data. For example, inadequate documentation could lead to a denial because claims were incomplete or inconsistent with other data. To ensure compliance with established standards, medical practices should have policies that establish appropriate documentation requirements for all patient services.
3. Reduce the Risk of Denials
Medical practices that properly plan their business operations can reduce the risk of denials by increasing the accuracy of their medical records and limiting information duplication between providers. This is especially true when medical practices need to request several different services after referred patients have initiated treatment. It is also essential for medical practices to maintain physical documentation of all services and changes in patient status, which should be a part of the standard operating procedures.
4. Create a Practice-Wide Culture of Compliance
Medical practices can avoid denials simply by having knowledgeable staff members who identify questionable contradictions and who can act as the point-person in providing feedback to their practice’s clients. Ideally, this may be achieved through ongoing training and education, mentoring programs, and ongoing review of staff’s documentation processes. While each medical practice needs the right individual with the right skills and talents, running a practice with effective compliance policies can quickly prevent or resolve a denial, leaving less time and effort for addressing denials.
5. Identify Denial Resolution Early on in the Process
Denials are rarely the result of intentional misconduct by medical practices. It is far more common for denials to occur because of inadvertent errors. Denial management companies may provide assistance so that your medical practice can smoothly navigate the denial and appeal processes.
6. Keep an Eye on the Technology
As medical practices look to remain compliant with healthcare regulations while remaining competitive in the marketplace, they are encouraged to evaluate their technological infrastructure. Medical practices may have a variety of technologies that could be used more effectively to assist with compliance investigations; this includes paper-based records, old computer systems, and outdated software. These issues should be evaluated often to ensure that all the tools necessary for patient care are in place and effective for practice operations.
When medical practices look at the number of denials they receive, they can use this information to develop strategies to reduce the number of denials they receive. Medical procedures can also review their data quality to determine the weaknesses and work proactively to remedy the situation before they accrue more penalties or denials. Medical practices need to take advantage of an expert in denial management’s expertise and become familiar with the fines associated with these denials.