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Revenue Cycle Management: Preventing Claim Denials

Preventing denials requires careful documentation but physicians don’t always make the connection between poor documentation and declining revenue. As a result, some offices get stuck in a downward spiral that’s difficult to reverse without a coordinated effort between the front and back office.

Revenue cycle management experts I spoke with had some great tips for reversing that negative trend. Here are 5 worth noting:

Communicate. Physicians, nurse practitioners, and physician assistants should receive frequent, direct feedback about the quality of their documentation. Whether your billing staff is medical revenue cycleon-site or you work with a third-party, you need to know how often and why your claims are denied. Consider having regular staff meetings or online discussions focused on billing and coding.

Test for coding competency. Perform a baseline assessment of providers’ coding skills and repeat it twice a year to make sure everyone is up to speed.

Invest in training. Both newly hired and established providers should undergo regular training and refresher courses on coding and documentation. Remember: poor documentation + inaccurate coding = denied claim (and lost revenue).

Show them the money. Complying with coding audits and attending educational seminars should be tied to financial compensation and/or bonuses.

Use technology. “Scrubber” tools embedded in your practice management system search for coding errors and generate reports on recurrent problems–consult them regularly to avoid repeating common errors.


Please see the longer version of this column that I wrote for Physicians Practice.







Revenue Cycle Management: The Front Desk

Your first chance to avoid a denied claim happens when a patient walks through your door. It might start with seemingly inconsequential errors, like leaving one letter out of a patient’s name, but those small mistakes get compounded as they move through the coding and billing process. Down the road, that one missed letter could end up costing hours of precious staff time and significant delays in getting reimbursed for that visit.

The key is making sure your front medical office revenue cyclestaff is well-trained and prepared to gather all necessary information before, during, and after the visit. That means being diligent about verifying insurance coverage and becoming familiar with different policies in order to educate patients.

Consider these tips for avoiding front-end mistakes that can cost you down the road:

Verify insurance in advance. Ask the patient about their insurance coverage when you schedule the visit, follow up several days before their appointment, and re-confirm  when they arrive in the office. Double check their phone number, address, and other personal information.

Follow up on errors. Coding and billing staff should alert staff at the front desk about any frequent errors that are causing denials so they can modify their procedures accordingly.

Be clear about costs. A cost estimating tool integrated into your practice management system can generate a quick estimate of patients’ financial responsibilities for upcoming services or procedures. These are often available through insurers.

Talk to patients. Knowing the details of a patient’s visit upfront will help you schedule it appropriately. For billing purposes, keep preventive services, such as a mammogram, separate from procedural visits, such as skin tag removal.

Think of time as money. Front desk mistakes, however small, aren’t just annoyances because they ca lead to multiple delays. When a denied claim arrives, someone has to spend time investigating the reason, correcting the error, and resubmitting the claim. And if it takes longer than 90 days, that money could be lost for good.

For more information, check out a a longer version of this column that I wrote for Physicians Practice.









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