6 Ways to Reduce Claim Denials with Healthcare Revenue

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Medical billing denials are a continual nuisance for finance executives at hospitals and health systems and their employed practices when it comes to revenue, cash flow, and operational efficiency.

However, there are ways to prevent many medical billing denials. Although they may never be zero, even a fraction of a percent reduction can significantly influence your bottom line. Understanding the many forms of medical billing denials, identifying the most prevalent billing issues, and taking action to avoid them is a solid strategy. You can also use healthcare BPO services to reduce your medical claim denials. Let’s dive deep into the things you can do to prevent claim denials:

1. Educate And Inform

The ability to effectively communicate internally and externally is critical in any organization, but this is especially true in the rapidly evolving healthcare sector. For best financial outcomes and customer satisfaction, it is critical that every team member, from the front desk to your medical staff and the back office, understands their function and its relevance to your success.

Aside from knowing the services you offer, your team needs to know about each patient’s insurance covers, their co-pays and deductibles, and the correct codes for each service. Missing even a simple flu vaccination payment may add up. To avoid making mistakes, team up with a healthcare BPO services company.

Communication, ongoing education, and up-to-date certifications are essential to keeping your staff up to date on the newest healthcare developments.

2. Improve Your Revenue Cycle Management

Front-end revenue cycle management activities, such as patient registration and scheduling, should be given special attention because most claims are denied due to incomplete or inaccurate data.

When it comes to the revenue cycle, collecting accurate information upfront is essential. This lays the foundation for the most effective and successful billing and collection of claims.

Getting a claim submission rejected and then dealing with the institution is the last thing you need. Getting the information to the patient and their family in a friendly manner upfront might save them a lot of grief if the claim is filed and approved correctly. A healthcare revenue cycle management services company will take care of all this for you.

3. Get insurance verification before providing service.

The need for early eligibility verification in healthcare finance cannot be emphasized, just as it cannot be in real estate, specially to avoid rejections or write-offs. Don’t assume that long-term patients haven’t had an insurance change owing to a work shift or loss or the age of 65 and joining Medicare or other variables that influence coverage. All these coverage elements are subject to change from year to year, even for the same policy. To be safe, verify a patient’s insurance coverage before every visit. If you don’t want to handle all the hassle that comes with it, you may want to employ healthcare BPO services so that you can focus on your patients.

4. Take Advantage of Modern Technology

Investing in practice management or even something like an electronic health record system is expensive and time-consuming. It’s a complete waste of money if no one on your team uses what you’ve paid for. Everyone in your company should be trained to utilize the same system so that important information does not fall through the cracks. You could also take the help of a healthcare revenue cycle management services company as they will always have the latest technology.

 It’s essential to keep in mind that most healthcare delivery mistakes occur during “handoffs” – between shifts or departments in hospitals, between the Practice Management and Electronic Health Record system in practices, or between the front and back office.

5. Learn from Your Mistakes

Everything has a pattern. Study your denials and figure out why they are being denied. Is there a recurring reason for this? Then, start working on your mistakes. Healthcare is an industry that changes so quickly that this step is sometimes ignored amid daily patient care and billing responsibilities. The devil is in the details, and they’re constantly changing.

6. Change Starts at The Top

Adapting to a constantly changing technology society might be difficult, but it is unavoidable. This is especially true in the healthcare industry. As a healthcare provider, you must be open to new ideas that will improve your practice’s financial stability and allow you to continue to serve patients.

Leaders who are open to new and better ways of doing things must be at the organization’s top. When members of a group see their words put into action, they are more likely to follow suit. Taking the help of healthcare revenue cycle management services can be a positive step that the leaders can take so that healthcare providers can focus on what matters – their patients.


Since laws and payment requirements are continually changing, many hospitals and clinics do not have the technology or manpower to efficiently manage denials. You can take the help of an healthcare revenue cycle management service providing company with a specialized denials management staff. Medical billing benchmarking, backlog reduction, root cause analysis of rejections, and revenue cycle team augmentation are some of the services that a healthcare BPO services company will provide for you.

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