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How to Prevent Claims from Being Denied

Last month, we shared the five ways Mednet makes you more money. Although the list was in no particular order, the first item was submitti ng accurate claims. As this infographic illustrates, the average cost to file a claim is $6.50. The infographic also details that the cost to resubmit a claim ranges anywhere from $25-$118. The total cost to submit, correct, and resubmit a claim can range anywhere from $31.50 to $124.50costing your practice thousands of dollars per year.

Here are some other troubling numbers from a report on

  • According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20% of all claims submitted
  • As many as 65% of claims denials are never worked, resulting in an estimated 3 percent loss of net revenue
  • Roughly 67% of all denials are appealable

We are not sure about you, but losing 3% net revenue does NOT sound like the best way to run a business.

Mednet gets paid on over 98% of all the claims we submit, so we firmly believe we are experts in preventing claim denials. Here are some of our top tips to help you prevent your claims from being denied:

Do Your Homework: Part I

The only real constant in the medical industry is the change. Your staff must be on top of any and all changes in rules and regulations. By fostering an environment of constant learning and improvement, everyone on your team will understand the importance of staying up-to-date, eliminating denials due to failure to keep current.

Do Your Homework: Part II

Look internally and investigate the cause of past denials. Understand where mistakes may have occurred and how you can avoid them in the future. If necessary, implement corrective actions to curb future denials.

Work As A Team

Denied claims affect the entire practice. Everyone on your staff should understand this. Even if they do not work directly with billing, each staff member should do their part to ensure the billing process is a smooth one. Help your team communicate what is needed, and, when a mistake happens, do not rush to place blame. Take time to search out the cause and help them understand how to prevent it from happening in the future.

Make Sure Pre-Authorizations Are Done Correctly

Pre-authorizations can help lower the number of claims denied, but only if they are for the scheduled procedure. Carefully document what was authorized and do checks before the procedure. If anything changes, document what was changed and double-check everything before submitting the claim.

Work Smarter

This is a broad category that encompasses the above points, but also includes:

  • Incorporate automation: Many software providers have tools that will help automatically update codes and procedures. Tools like this, as well as other project management tools, streamline the billing and claims process.
  • Review your work: This seems like a simple step, but for one reason or another, it is often overlooked. Working as a team can help with this step because it is easier to spot someone else’s error than to catch your own.
  • Meet deadlines: Meeting deadlines is essential. There is no excuse for having a claim denied because you missed a deadline. Again, working as a team can prevent a missed deadline.

In the end, you can help prevent claim denials by setting up a process for your team to follow. Set up a system that you can repeat for each claim that also allows for periodic review so you can determine where you need improvement.

It may seem daunting, but can you truly afford not to follow a process? It can cost you as much as 3% of your net revenue.

If it’s still too overwhelming, remember that Mednet is here to help with your medical billing needs. It might be a worry we can take off of your plate so you can focus on more important things, like your patients.

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Five Ways Mednet Makes You More Money

Running a medical practice is difficult. No matter your specialty, you most likely face many challenges: compliance, administrative requirements, staffing issues, managing your revenue cycle, and cash flow. That is a lot to deal with, and we did not even mention ensuring your patients are happy and healthy.

Given all that goes into properly operating a medical practice, it’s important to know that help is out there and, even more importantly, how that help can propel your practice towards growth.

That’s where Mednet comes in. And there is one challenge we are exceptionally good at: ensuring your practice makes more money.

Let’s take a look at exactly how we do this:

Accurate Claims Billing

It all starts with submitting accurate claims. Because claims is how your practice gets paid for the services you provide for your patients, if the claims you submit are not accurate, they can be rejected or denied. And the process to clarify any errors can be costly in terms of both time and money.

Mednet gets paid on over 98% of all claims submitted. When we submit a claim for you, you’ll know that it is accurate. You will not have to worry about wasting time and money fixing inaccurate claims and delayed payments.

Improve Coding for Higher Reimbursement

A major part of submitting accurate claims is proper coding. Knowing which codes and modifiers to submit for which services you provide ensures that your practice does not lose any revenue. But it can also be a very complicated process, and one you need special knowledge to do correctly.

Mednet’s team of certified coders are trained in coding and chart audits. No matter your billing coding needs, we can meet them.

Aggressive A/R Management

No matter how experienced or good you are, claims do get rejected or denied. As stated above, resolving these issues can be costly. And if you fail to resolve the issues, you are leaving money on the table.

Mednet is aggressive in A/R management and and follow best practice standards. If a claim is rejected or denied, we quickly and efficiently follow up on your behalf to ensure there is no lost revenue.

Dedicated Account Managers

When you work with Mednet, we assign a dedicated account manager who handles all aspects of your medical billing needs.

Over time, your account manager comes to know your business and will feel like part of your staff. This strong relationship is important when it comes to handling the day-to-day challenges of medical billing.

Extensive Knowledge of the Industry

Mednet has been in business for over 30 years. Our Management Team has over 100 combined years of experience working in the medical billing field. We know the “ins and outs” of revenue cycle management, and you will feel confident that you are working with trained, experienced, and educated professionals who know how this industry operates.

You have a lot to worry about when it comes to operating your practice. Why not take something off your plate, a worry off your shoulders? Mednet gives you peace of mind because you know that the billing and coding is being taken care of.

Don’t waste any more of your precious time or money. Contact Mednet today to see how we can help revolutionize your medical practice.