Do you feel like your Dermatology practice [or any specialty] isn’t earning the money that it should? Because you’re working harder than ever. Maybe you’re seeing more patients or doing more procedures, but it’s just leading to more work and not really more income.
Or you’re a medical billing and coding specialist or an office manager in charge of billing and you are being put on the spot. Called to the carpet about Denials and Aging Accounts Receivable and not knowing where to turn to improve your department’s performance.
There are only a few reasons that we’ve found for consistently high Denials that should be on your radar.
We’ll review those below, but first:
Rejected Claims are not the same as Denied Claims
When an insurance company flat out rejects a claim, it’s because something was obviously wrong or missing from the paperwork.
- Wrong spelling of the name
- The wrong insurance company was billed
- Incorrect policy number
- Group plan information is incorrect
Normally, as you can see, the fix is simple. Correct the errors and resubmit.
But if you are experiencing regular rejected claims, you have a personnel or process problem. This is actually a red flag that our Practice Management and Audit teams would pounce on.
If you are doing in-house Dermatology Medical Billing and Coding, then it’s most likely your Coders or Billers just are not paying close enough attention to the details. Or something about your system is actively presenting them with the wrong information.
You might consider a personnel change, or at least complete retraining. And look at your systems from the ground up.
If you’re getting regular Rejected Claims and you’re using an OUTSIDE billing service – you should fire them and find another. We’re happy to help, but if not us then choose a service that’s more careful.
This is a great opportunity to take advantage of our Free Practice Audit. We can help you identify the issues and plan corrections.
Reasons your Claims are Denied
The Medical Code doesn't match the procedure correctly
This can happen frequently with inexperienced or less experienced medical coders especially. And especially if you treat under both private insurance and Medicare. One insurance may reimburse for a specific code and another will not.But they may reimburse for an overlapping code that still describes the procedure accurately.
Your Patient Needed Pre-Authorization
There is definitely some overlap with the Code Matching description above. But the difference here is that the procedure itself needed to be pre-authorized by the insurance company.
While this is the patient’s responsibility, a talented coder or practice manager will pursue a resolution BEFORE it’s a problem.
Missing Information
One of the most frustrating Denials comes when a claim is sent back because one of the boxes on the form is left blank.
Duplicate Claim or Service
Sometimes it’s as simple as you or your staff submitting the claim twice by mistake, or submitting 2 procedures with the same codes entered by mistake.
Filing Time Limit Expired
A well-run billing and coding department should never experience this one. Especially on the first submittal.Where even veteran medical coders make this mistake is usually on RE-submittals.In other words, the claim is made within the expiration time period provided by the insurance company – it’s denied – and isn’t resent with corrections on time.During a Free Practice Audit, we did for a dermatologist recently we found that the person in charge of submitting the claims NEVER re-submitted denials.
Every week or month this busy practice would send their invoices/claims to the insurance companies, and one or more would be denied for some error. And the clerk would just write that off instead of fixing and resubmitting.
The Physicians NEVER KNEW!
Outsourcing Medical Billing and Coding Makes Sense
In every case outlined here regarding why your claims are being denied, using a professional medical billing and coding company like Integra Medical Billing & Practice Management would solve the issue.
Because we have in-house, experienced, CPC Certified medical coders and billers that do that job all day, everyday. They’re completely immersed in and take huge pride in getting ZERO DENIALS. And they do that by getting everything right the first time.
If you’re using your own billing clerk, depending on your volume they may be doing double duty. Performing some other office/admin tasks. And once their attention is split, you’ll see Denial rates rise.
Your in-house team, or even a cheap outsourcing service that uses work-anywhere coders, just isn’t paid enough to work HARD and not just getting submissions correct, but getting the most dollars for every. Single. One.
The way that our team works, each medical coder is rewarded for their work based on COLLECTIONS. And they’re surrounded by others of their same quality, with the same goal.
And they’re managed on-site by a company OWNER that is a certified coder herself.
The atmosphere of excellence and unwavering pursuit of ZERO DENIALS makes our team the best in the business.
If you have Denials at any percentage, we can help. And when we do, your practice income with go up significantly.