Reduce denials in five easy steps

Tracking and reconciling denials are extremely crucial for every medical practice. They form a metric for practice performance and are a direct reflection of reimbursements. They also reveal loopholes in practice operations.

Practices typically decide a day/s on which they would act on denials. For example, if a practice decides to work on denials every Friday, the denials don’t wait for Friday to pop up. They keep accumulating since the first day of the week and become a pile by Friday. And the practices are left intimidated and overwhelmed with what they see.

Daily denial management is an effective tool to manage denials in a more methodical manner. By definition it means getting a sense of what your denials are on a daily basis and equipping yourself the tools required to tackle the denials. Its relatively simple to practice, doesn’t take a lot of time and the outcomes are significant.

Here’s how you can implement this process in your practice:

1. Know the nature of denials.  Which are the top denials for your practice? Which denials are more frequent than the other.

2. Create relevant “buckets” for the denials eg. Denials requiring medical records, incorrect coding, coverage dependent (eligibility, benefits, authorizations), deliberate denials by payors, those requiring appeals… you get the point.

3. Before the end on each day get a load of all the denials you have come across that day.  If you do the billing yourself, then you can easily make out the denials from the EOBs or ask your billing department to get the report for you – its fairly easy.

4. Categorize the denials into the buckets that you have created.

5. List down the action requirements for each bucket.

Once you employ this practice you’ll see a pattern emerging for the denials. You will notice that most denials are consequences of something that you had missed. Go back and fix the missing, not only for that particular claim or denial but for the process, for e.g. there has to be a 59 modifier associated with 45380 – Colonoscopy with Biopsy when billing with 45385 – Polypectomy – Polyp removal – make a note of such coding updates and use them every time you submit same procedures.

When the process is fixed the denials will reduce. With every fix the process becomes stronger. As little as an hour can save you dollars and time.