Claim denials are the worst. You provide your patients with exceptional therapeutic intervention—and bill their insurance companies to recoup payment for those services—only to find out that the payer has no intention of actually doing any paying. Womp, womp. While you could—and should—implement a process to correct and rebill denied claims, wouldn’t it be even better to stop them from happening in the first place? After all, it costs providers an average of $25 to rework a single denied claim (according to a 2014 MGMA report). That means you’re actually spending money—and a lot of it—to recoup what you’ve already earned. And it’s time to change that. Here are four strategies to help you achieve first-pass claim payment:
1. Prioritize clean, promptly filed claims.
As WebPT President Heidi Jannenga pointed out in this Founder Letter, many denials result from simple demographic information errors, such as “entering the wrong date of birth, misspelling the patient’s name, or recording the wrong address.” According to Diane McCutcheon, others occur because of:
- Incorrect insurance information
- Missing data (e.g., ICD-10 codes, G-codes, and modifiers)
- Missing or invalid referral/authorization information
- Issues with credentialing or providers
- Submission outside of that carrier’s timely filing window
- Failure to provide requested information
While ensuring your claims all go out clean, on-time, and error-free might seem like a no-brainer, it’s a step that—unfortunately—often gets overlooked. With that in mind, consider establishing a process that makes doing so a priority—specifically, one that begins with your front-office staff verifying patient insurance eligibility within 72 hours of the first interaction with that patient (or, at the very least, before the patient receives treatment). That way, you can be sure:
- you have the correct patient information on file,
- the patient’s insurance covers your services, and
- you comply with any individual carrier requirements (such as preauthorization or additional documentation requests).
2. Make it a team effort.
Front-office personnel aren’t the only ones who should own the responsibility of ensuring first-pass claim acceptance; everyone in your office has a role to play in minimizing denials and maximizing payments—as well as a motive for doing so. That’s because a lack of payments could negatively impact your clinic’s solvency as well as everyone’s take-home pay. So, loop in your whole team, communicate the importance of working together to achieve this very important goal, and develop a culture of accountability, so everyone on your team is committed to doing what’s right for your patients—and your practice.
3. Demand defensible documentation.
As I wrote in this post, “Defensible documentation supports a provider's decision to not only provide specific services, but also bill for them.” Thus, the strength of your therapists’ documentation can actually be the difference between getting your claims accepted—and having them denied. And it should come as no surprise that frequent claim denials can be detrimental to your bottom line. Not to mention that a continual lack of defensible documentation could put you at an increased risk of an audit—and that’s no one’s idea of a good time.
4. Identify—and solve—existing problems.
It may be tempting to ignore denials—after all, a few denials here and there are to be expected, right? Not necessarily. Often, even one denial can be indicative of a larger issue—a bigger gap in your current clinic processes—that, if left alone, may get worse. And that means you’ll probably experience even more denials down the road. In this post, WebPT’s Charlotte Bohnett encourages providers to identify—and log—the error codes for all denied claims in order to suss out trends that point to the root cause. (Of course, that’s on top of the steps you should already be taking to correct and rebill the denied claim per the payer’s instructions.)
Looking for even more great strategies to prevent denials? Register today to attend “Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid”—a free webinar WebPT President Heidi Jannenga is co-hosting with claim denial expert Diane McCutcheon on May 24 at 9:00 AM PDT / 12:00 PM EDT. Can’t attend live? Register anyway, and we’ll send you the recorded version via email a few days after the event.