9 Best Practices for Avoiding Common Medical Claim Mistakes

Medical claims software is designed to manage and process healthcare billing and claims more efficiently. Poor claims management leads to claim denials, which strain resources, disrupt cash flows, and impacts patient satisfaction. A recent study found that claims processing maintained its status as the second most significant factor in “wasted healthcare dollars” in the US over a decade. Those wasted dollars climbed to $265 billion by 2019. Integrating medical claims software reduces many of  the common errors that cause claim denials in medical billing. Optimizing your claims management process improves accuracy and expedites the reimbursement processes.

Best Practices to Avoid Medical Claims Denials

While having a medical claims software can help increase the effectiveness of your claims processing and reduce medical claim denials, even with advanced technology, you can increase the number of denied claims without implementing best practices before submission. Below we will explore nine best practices to avoid common mistakes that often result in increased medical claims denials.

No. 1: Ensure You Are Collecting Complete Patient Information

Insufficient patient intake information often leads to claim denial. That means the foundation for successful medical claim submissions is a thorough patient intake process. Your practice must emphasize comprehensive and accurate data collection. Patient intake software can streamline the collection of essential details. It ensures that the claims management process starts on a solid foundation. The result is a significant reduction in errors related to incomplete patient data. This software automates data collection and integration, creating a seamless transition of information throughout the healthcare cycle.

No. 2: Verify Insurance Eligibility On Every Claim

Failing to verify insurance eligibility is a quick road to claim denials and delays in payment. A medical billing software with insurance eligibility verification features can help prevent these issues. With it, you can automatically verify a patient’s coverage before services are rendered.

This is true as well for prior authorizations. Prior authorizations can be complex and time-consuming, often delaying claim processing. Automating verification and authorization streamlines this aspect. This automation ensures compliance with insurer requirements and expedites the approval process. Healthcare providers can focus more on patient care and less on bureaucratic hurdles, resulting in faster treatment and expedient billing cycles.

No. 3: Ensure Accurate Medical Coding

Another common cause for medical claim denials is inaccuracies in medical coding. These errors might have various causes, including:

• Misinterpreting patient records
• Incorrect code entries
• Outdated coding guidelines

Accurate medical coding is crucial to prevent claim denials. Maintaining up-to-date knowledge of coding guidelines is an essential strategy. It’s also important to emphasize regular training for coding staff. This approach ensures that coding practices are accurate and conform to the latest industry standards. 

No. 4: Avoid Manual Processes That Can Lead to Mistakes

Anything handled manually is prone to a variety of errors. One of the most impactful mistakes is duplicate billing, which can lead to claim rejections. Duplicate billing can happen when staff members enter the same service multiple times or bills for services not rendered. Both of these issues are common when staff manually enter data. Using effective medical billing software can identify and eliminate these duplicate entries.

No. 5: Proper Training to Avoid Unintentional Upcoding & Unbundling

Unintentional upcoding and unbundling can greatly disrupt billing and increase claim denials. Let’s first define the terms: 

• Upcoding: This practice involves healthcare providers submitting codes for more severe (and costly) diagnoses or procedures than were performed. It is a form of fraud that can result in severe financial penalties and legal consequences.
• Unbundling: This term refers to submitting separate bills for procedures or tests that should be billed together under a single code. Like upcoding, this tactic illicitly increases reimbursement from healthcare programs or insurers.

These practices breach ethical standards and burden the healthcare system with unnecessary costs. That is why detailed staff training in correct coding is essential. Conducting regular audits is also important in mitigating these practices.

No. 6: Pay attention to Claim Submission Deadlines

Delays in submitting claims are a significant factor in claim denials. Insurers often have strict deadlines for claim submissions; missing these can result in non-payment, even for legitimate claims. Effective claims management software can automate the tracking and timely submission of claims. As a result, all claims are filed within the insurer’s specified time frame.

No. 7: Keep Updated on Provider Requirements & Regulations

Healthcare practices that stay informed about the latest healthcare regulations find it easier to maintain compliance and ensure accurate claim submissions. Claims management software can also help because it constantly updates to reflect new and changing regulations. With this information on hand, providers can easily adjust their practices accordingly. Every claim they submit will meet the current standards, reducing the risk of denials due to non-compliance.

No. 8: Utilize a Comprehensive Clearinghouse

A clearinghouse can significantly improve the accuracy and success rate of a practice’s medical claims. It acts as an intermediary, thoroughly checking each claim for two critical factors:

• Correct formatting according to the latest ANSI standards
• Validation against Strategic National Implementation Process (SNIP) and payer specific edits

This pre-verification process minimizes errors that could lead to rejections or denials, increasing approval rates. Streamlining submissions also speeds up the reimbursement cycle, benefitting healthcare providers and patients.

No. 9: Use Office Ally’s suite of products

With Office Ally’s suite of products, you can reduce claim denials and streamline your billing process. With Service Center, Office Ally’s all-payer clearinghouse portal, you can simplify eligibility and claim management easily with a quick and affordable solution. Use Practice Mate to streamline front and back office tasks with our secure, reliable Practice Management Solution. Inspire fast clinical workflows and reliable patient records with our Electronic Health Record solution EHR 24/7.

Embrace Office Ally’s solutions to improve your claim approval rates and optimize your reimbursement cycle. Start minimizing errors and improving your financial health today by integrating Office Ally into your claims management strategy.