Reducing Medical Billing Claim Denial

The key finding of The American Medical Association's (AMA) 2010 National Health

Insurer Report Card is that one in five medical claims are processed inaccurately by health insurers. According to the AMA's findings of the nation's participating seven largest commercial health insurers, the health insurance industry as a whole has about an 80 percent accuracy rate for processing and paying claims.

Consider these statistics:

A one percent improved claims processing accuracy creates an estimated savings of $777.6 million in unnecessary administrative cost.

As much as $ 210 billion annually is spent by the health care system on claims processing.

The equivalent of five weeks of physicians time is annually spent on health insurer red tape.

As much as 14 percent of physicians divert of their revenue to keep up with the administrative tasks required by health plans and to ensure accurate payments from the same.

The systems health insurers use to process and pay claims were measured according to:

- Accuracy

- Denials

- Timeliness

Since denied, rejected, resubmitted and underpaid claims can cost you as much as $100,000 per month according to the AMA, every effort you can make to reduce denials, rejections and delays will mean money to your bottom line.

An effective strategy is implementing an automatic insurance benefits verification system before the patient sets the appointment. In many practices, the standard process is to check insurance eligibility when the patient arrives for the appointment. This is a good time to check eligibility but not the best practice to optimize your cash flow.

This will enable your employee, and/or your billing account representative to immediately identify patients that may have changed carriers, have pre-existing exclusions or large deductibles. Plus, this will improve patient relations because your patients will know and be prepared, in advance, of their financial responsibility. Also, you can then immediately collect patient portions at time of service. This will increase your cash flow right there.

Be sure to save the verification information in the patient's account, in case there are any disputes later with the insurance company over when or if the eligibility verification occurred.

You can significantly reduce overhead with practice automation features such as automatic eligibility verification. Electronic verification can eliminate up to 50 percent of denials on the spot and save your staff from hours on the phone.

This strategy, along with offering a pay by credit card option along with storage of information, will substantially reduce your accounts receivable.

by: Ronald McLaughlin

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