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How to Avoid Claim Denials as a Holistic Practice

Your holistic practice’s health insurance denial rates are some of the most significant indicators of your medical billing success. Unfortunately, they’re also one of the most difficult elements of your billing operation to improve. If you’re not paying close attention to your insurance claim denials rate, you’re jeopardizing the financial stability of your practice. By following these best practices guidelines, you can avoid insurance claim denials and achieve your holistic practice’s overall revenue potential. 

What Are Insurance Claim Denials?

The medical billing process is integral for practices to receive reimbursements from health insurance companies. When patients utilize insurance to pay for treatments, healthcare providers have to submit claims so they can be paid for their specific services from the insurance companies. While medical billing ensures that holistic practices receive their due payments for treatments, it’s also a complex process. Insurance billing claim

If claims are missing information or filled out inaccurately, then they can be denied by the insurance companies and stymie the reimbursement process. Insurance claim denials are frustrating to any holistic practice; not only is the payment completely denied or delayed, but the time it takes for reimbursements can extend to weeks or longer. For the most timely and full reimbursements, holistic practices must keep denials in medical billing as minimal as possible. 

Common Reasons for Claim Denials

The five most common procedures denied for holistic practices are:

  1. Manual therapy
  2. Heat/cold therapy
  3. Office/outpatient established visits
  4. Injections
  5. Acupuncture services.

For strong revenue cycle management, holistic practices should aim for a 95% clean claims rate; maintaining a high clean claims rate increases your practice’s efficiency and overall profitability. So, how can your practice avoid insurance claim denials and maintain a strong clean claims rate? Here are some of the top reasons for denials in medical billing: 

Lack of Coding Specificity

Especially in the ICD-10-only landscape, claims that aren’t coded to the fullest level of specificity possible are ripe for denial by both public and private payers. That means that all identifiers and modifiers must be included on every claim, every time, covering concerns as granular as possible.

Billing Duplicate Claims

Even in well-organized operations, it’s surprisingly easy for practices to submit claims relating to the same encounter more than once. It may happen when a team member resubmits a claim before hearing back from the insurance company on the initial submission or fails to check on existing documentation as to whether the claim was submitted from the start. Either way, it’s an easy ticket to an unnecessary denial.

Timely Filing

Organizations often see unnecessary denials for failing to submit claims within the payer’s filing window. Why do practices wait? While reasons vary, the issue usually comes down to bandwidth and time: If your staff is stretched too thin, it’s impossible to address all of your front-office and back-office responsibilities in a timely manner. Contracting with a medical billing company is a smart way to keep filing deadlines from slipping past you.

Unverified Insurance

Insurance claim denials can be the byproduct of established patients updating their insurance without letting your practice know. Staff members may assume that regular patients have not had any changes to their insurance. However, if there have been changes to their insurance and no one checks their eligibility, then you might be headed straight for denials. Verifying your patient’s insurance at every visit can ensure there are no insurance-related issues during the billing process.

Best Practices for Avoiding Insurance Claim Denials

After learning the common reasons for insurance claim denial, try the following denial management tactics!

Track Every Claim

No claims should ever get “lost” in your practice management system. If that’s happening to you, it’s imperative to implement a more comprehensive process for tracking where claims stand throughout the entire revenue cycle. In many cases, claims slip through the cracks because they’re not handled fast enough by the team at your practice. Make sure your coders are coding every encounter on the same day as the date of service, then upgrade your technology to a system that scrubs, submits, and monitors claims with minimal employee effort.

Medical Billing Claims

Identify the "Why" In Your Insurance Claim Denials

Simply put, you can’t lower your denial rate if you lack an understanding of why your claims are being denied! Review all of your denial notices from a set period – for example, three or six months – and log the associated reasons for the denial. Look for patterns, then talk it out with pertinent staff members to get back on track.

Follow Up In Time

Most denials can be corrected and resubmitted within a given time frame, which varies from payer to payer. Find out what the window is for each of your major players, and make sure it never slips past you. Better yet, create a window of your own, like five to ten days, during which it is your billing team’s top priority to follow up on every denial and correct or appeal when appropriate.

Automate Eligibility Checking

Unfortunately, many holistic practices handle eligibility checks in an unstructured, unsophisticated way – heavy on last-minute calls to payers in advance of a patient appointment, or sometimes even after services have been rendered. Neglecting eligibility checks - or managing them in an outdated way - is a disservice to your patients and practice!

Reduce Your Claim Denial Rate with Holistic Billing Services!

By using these tips to reduce your holistic practice’s claim denial rate, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.

With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.

Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!

October 6, 2021
 - by Antonio Arias, MBA, CHBME
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