Claims denial is, understandably, a cause for great concern among ASCs. Not only can denied claims disrupt your organization’s cash flow by adding up to 45 days to the revenue cycle, but they can also eventually leave a serious gap in projected income. The problem is only exacerbated when you add in the cost of following up denied claims.
Your ASC is a busy place, and you don’t exactly have time scheduled out every week to check in on your billing department to see how things are going (and you shouldn’t have to!). That’s why it’s important to have a good RCM in place because prevention is better than cure.
In fact, it’s estimated that up to 90% of denials could be prevented by proper billing and AR management. But even that won’t completely remove the issue because working in healthcare means you’ll always face a number of claims denial. It’s a matter of how you deal with them, however, that affects your bottom line.
- Address Denied Claims Without Delay.
Imagine what would happen if every claim your ASC submitted was denied. It’d have a disastrous impact on cash flow and would eventually lead to shut down because there’d be very little money coming in! The reality is that you can’t keep your ASC open if you’re not getting paid, and that’s why every denied claim should be addressed as a matter of urgency.
Denials should be followed up within 48 hours or less after being received. Each of these follow ups should be noted in detail, and your ASC should have a predefined action plan as to when the next follow up is due.
If there’s anything unclear about the denial notification, the carrier should be called immediately for clarification to prevent further delays. It is, for example, possible that your ASC’s submission procedures don’t comply with the carrier’s requirements. If this is the case, then it’s an easy fix and future delays could be virtually eliminated by a few simple tweaks to these procedures.
- Be Persistent in the Process.
If a claim is denied twice, the next step should be to appeal the decision in accordance with the guidelines issued by the carrier. Make sure that all the required information is submitted with the appeal, and don’t forget that appeal procedures often vary from one state or insurance carrier to the next.
Your appeal should be accompanied by supporting documentation, such as a copy of the initial claim, as well as copies of all previous communications with the carrier. You should also attach solid reasoning for why the request should be reconsidered.
If the claim was denied on the basis of “medical necessity,” you may need to provide more information to prove that the treatment was indeed necessary. Remember that it’s extremely important to comply with the requirements of HIPAA (Health Insurance Portability and Accountability Act) regarding the protection of psychotherapy notes by providing only the minimum required information.
- Keep Proper Record of Disputed Claims.
When a staff member calls a carrier for additional information about a claim, make sure he or she keeps detailed notes of the information that’s provided, together with the full name of the representative they spoke with.
This information should be properly filed with other important information related to the claim, such as why it was denied, delayed, or partially paid. The actions your staff took to follow up on the disputed claim and the outcome should also be properly noted.
These records could prove invaluable in the future, especially if it becomes necessary to take the appeal to a higher authority, send complaints to the relevant state insurance commissioner, or take legal action. Documentation takes a little extra time, but it’s worth it since it can save you a ton of extra time (and make you more money) later on.
Improve Your Cash Flow with Trusted RCM Medical Billing Services
Working in the healthcare industry isn’t easy, especially if you’re stuck dealing with frustrating claims denials day in and day out. If you need expert help to maximize collections and revenue for your ASC, set up a quick consult with our team today. We’ve been in the business of helping ASCs maximize their profits for more than 25 years, and we’ll take the struggle of claims denial off your hands so you can focus on what matters most.