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4 Tips for Preventing Insurance Denials

When it comes to insurance denials, use the 80/20 rule. 80% of your denial issues can be fixed by addressing 20% of the problem.

  • Determine the actions needed to correct problems that have already been identified

  • Ensure your practice policies are updated and educate staff to prevent continued issues with identified problems

  • Utilize practice management software Rules Engine (if available)

  • Create a culture of zero balance tolerance for preventable denials.

Here is an example of an effective process for improvement you can follow to improve your efforts when it comes to insurance denials:

  1. Review the denial report and identify the reasons for denied claims

  2. Review the provider's enrollment process. - Provider may not be enrolled with some insurance plans - There may not be a good tool for tracking the enrollment process - Staff may not be aware of what insurances are not enrolled

  3. Modify Processes - Identify a better tool to track enrollment process - Escalate priority to insurance plans that are still pending - Verify correct enrollment applications have been sent to every health plan

  4. Educate Your Office Staff - Notify staff which health plans the provider is not yet enrolled - DO NOT schedule any appointments with patients that have these plans, or schedule with a different provider.

Contact or call 833.245.5633 to discuss how to improve your medical practice's billing, collections and credentialing processes.

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