Every medical billing has some denials. This includes Urgent Care billing. But if denials happen a lot and keep increasing, it’s a problem for Urgent Care practices. Reducing denials is super important in Urgent Care billing to get paid on time and right. This affects how much revenue a practice finally gets. So, here are steps to lower denials.
What is Denial Management?
In simple terms, denial management is a way to fix problems when medical claims are rejected. It also helps stop these problems from happening again so that doctors get paid quickly and have enough revenue.
The denial management team checks why claims get rejected a lot. They look at reasons like mistakes in paperwork or billing. Then, they fix these problems to avoid more rejections. They also check how different insurance companies pay and watch for any changes.
Why is Denial Management Important for Your Healthcare Organization?
Making sure your claims are right and can be processed by the insurance company is a big deal. It keeps your organization from losing revenue. There are four more reasons to use denial management:
It helps you find areas that need improvement so you don’t get denied in the future. For instance, an immediate care clinic in Algonquin or any part of the world can make more reimbursement if the practitioner can handle the denial wisely.
Denial management helps you track denials, determine which ones are most important, and appeal to them on time. You can use laws and rules to support your appeal.
By looking at patterns in denials, you can find out why they happen. This helps the denial team develop a real fix for the problems.
Denial management also helps you gather more honest information to support your appeal, which might get you more revenue from the claim.
What are the effective ways for denial management in urgent care practice?
Verify insurance eligibility
The billing process for urgent care starts right when you walk in the door. By having good revenue rules starting at check-in, you can make more reimbursements and avoid spending a lot on collecting payments.
Urgent care places usually don’t make you register before coming in because you can walk in. But the front desk person needs some basic billing info when you start your visit.
They need to know things like:
- Your essential info, like your name, address, birth date, and why you’re here.
- The name of your insurance company, your primary doctor, and your insurance policy number.
- Ideally, the info you give at the front desk helps create an electronic health record (EHR). The medical team uses this record to write down what they do, your health history, what they recommend for treatment, and more. Keeping a good record like this makes the billing process more accessible. If you visit again, they need to update any changes to your info.
Use Correct Codes
To get things right, use the correct codes when filling out claims. These codes include CPT codes, modifiers, and diagnosis codes. Double-check that they’re entered correctly in the billing system.
Prove Why It’s Needed
Show why the medical services you’re billing for are necessary. Explain how they helped the patient. This helps support your claim.
Be sure to send in your claims. Do it promptly to make sure they’re processed on time. If a claim takes too long, follow up on it.
Watch for Denials
Keep an eye on patterns where claims get denied. Check out denied claims to see what went wrong. Improve your processes to fix these issues. Train your staff so they know how to bill correctly.
Use tech tools to make billing more straightforward and more accurate. This could mean using electronic health records (EHRs), automatic billing systems, or other tech to simplify billing.
Outsourcing billing to third-party
By following these steps, urgent care centers can improve billing and reduce denied claims. But doing it can be challenging. The biggest problem is finding skilled and trained billing staff, which is hard for most urgent care places.
Because of this, urgent care centers are hiring outside experts to help with billing. These experts are called billers and coders, and they specialize in revenue cycle management in medical billing. When urgent care clinics partner with, they can easily follow the best practices we discussed earlier. This helps them manage their finances better and make more reimbursements.
Although revenue is not the priority of any healthcare practice, it is a necessary part of the access of healthcare organizations, whether you are doing it at a personal or organizational level. So, submitting the claim once it is denied instantly can help get maximum reimbursement chances. The above set can help you reach the ultimate denial acceptance and make more reimbursement.