Month: March 2016

End Denied Claims through Correct Practice Management Systems

March 28, 2016 Posted on Categories Billing Service, Practice Management Software

By Michelle Tohill


Maintaining a healthy business practice that profits while at the same time keeps your patients physically healthy can be a difficult task. Because keeping people well requires immediate attention in most cases, your staff may become preoccupied and busy. Businesses can only thrive if overhead, costs, and profits are sustained.

It is necessary to collect maximum reimbursements in order to continue providing exceptional healthcare to your patients. To ensure high cash flow and ongoing profits, practices must have consistent, high levels of reimbursement. Without it, your business will be impacted in multiple ways. You may have to cut or underpay employees which results in poor service. Under-reimbursed practices can create high levels of stress that can be extremely detrimental to the entire business.

One way to guarantee your business remains in the black is to minimize claims denials. An American Medical Association study attempted to estimate how much reworked claims can cost a practice. The results showed that medical offices waste about $14,600 each year on rectifying denied claims through appeals, phone calls, and troubleshooting.

Most practices are already aware of the hindrances that come with successfully submitting claims from their billing department.

Here is some advice on how to avoid losing $14,600 each year:


Regular Updates:

It is essential for employees to stay updated on any insurance policy changes that could affect patient’s coverage. Your billing department must be attentive for insurance policies regarding diagnostic codes and procedures. Signing up for insurance company emails and newsletters can be beneficial for staying informed. Having good practice management systems in place can also be helpful. These software systems should automatically update new changes on a regular basis in order to guarantee you have all the information for gaining reimbursements.



All denied claims should be investigated to determine why exactly it was denied. One of the most basic reasons claims are rejected is due to the code referenced being incomplete, invalid, or not matching the treatment stated by the physician. As mentioned before, many of these problems can easily be avoided through regular updates. These small coding mistakes can cost your practice thousands of dollars. Other causes for denied claims include timing issues, pre-authorization/authorization mistakes, and authorization period discrepancies. These problems are usually due to the patient not having the correct referral, failing to pay on time, or losing their insurance coverage. Having a practice management system in place can make investigations into denied claims much easier. Leaving denied claims as denied can cost you millions in profit.


Always Recheck Your Work:

Proof-checking your work can be monotonous and prolonging, but rechecking your claims can prevent potential errors. Spending time on this initiative can save time in the future and prevent substantial money loss. Allow your billing department enough time to double check claims or make sure your practice management system notifies you of errors.


Billing Comprehension:

Management should fully understand your practice’s billing process. This means being able to follow billing statuses and reports and relating them to the health of your company. Acquiring great technology and providing effective communication are important in achieving this goal.

These four tips can considerably assist practices in reducing or eliminating denied claims. As a result, you begin to receive the maximum reimbursement for your work.

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