How to Track Claims and Denials

One of the most difficult components of running a medical practice is dealing with insurance. Regulations can appear arbitrary because they are so complex, and even straightforward tasks can become time-consuming processes.

Tracking claims and denials is essential for making money. In order to avoid making the same mistakes that led to the first denials, you must follow up on claims.

According to Physician’s Practice, most clinics ignore this since dealing with denials is “more work than someone wants to go through.” But there are methods that can simplify the procedure. Here are four examples of how to do it.

Hire someone who specializes in denials

If you had someone whose main objective was to correct claims that had been denied, it would make tracking claims much simpler. From there, that person might either proceed with the appeal process or receive the money immediately.

Your claims analyzers will work more efficiently if you have one of these people on staff because they won’t have to stop every time a rejection comes their way.

Review accounts receivable

Recognize that you will normally have a 90-day billing window. Due to the generally lengthy response times of insurance providers, you can miss an opportunity to bill if you are not tracking accounts receivable. Any claim that hasn’t been paid after 60 days should be thoroughly investigated to make sure you haven’t missed the window.

Look for patterns of no payment

Codes and claims are handled in various ways by insurance companies. If you can spot trends in their payment, you can drastically cut down on rejections and simplify the tracking process as a whole. For instance, you can ensure that the right diagnosis code is included on claims for that treatment to reduce denials, appeals, and turnaround time if you are aware that a payer only pays for a procedure for certain diseases.

Stay committed to the appeals process

Do you know that more than half of all appealed denials result in payments? Most of the time, a corporation won’t go through the appeals procedure, particularly if the sum is very little. Or they’ll give up after getting one rejection.

The majority of appeals can actually be won if you put in the necessary effort. This could entail third- and fourth-round appeal attempts. The majority of practices will choose to “eat” the costs because they are either unwilling to do this or lack the time.

A medical billing company can be useful in this situation. They will vigorously appeal until you receive payment while fighting for your reimbursements. We at A2Z Precise Medical Billing Services can help you with that.