October 30, 2012 by Rick B
Almost everyone has had to deal with the unsavory task of contesting a denied or rejected insurance claim. Whether you are a consumer or a professional in the healthcare industry, denied claims correlate directly with lost money. For the consumer, it’s often an overwhelming task that leaves them scratching their heads, and for the healthcare professional, it is a loss in the form of uncollected revenue.
It could go without saying, but losing out on money you’re entitled to is, for lack of a better word, troubling. While denied insurance claims are undoubtedly a point of pain for consumers, our discussion today will focus on the impact these denied claims have on healthcare organizations.
Unfortunately, there is no one problem that can be blamed for the lost revenue created by rejected and denied insurance claims—If only it was that easy. Truth be told, there are several contributing factors that can lead to substantial reductions in revenue if they are not addressed.
Contributing factors that lead to rejected claims include, but are not limited to the following: failure to verify insurance benefits/eligibility, coding errors, and unsubstantiated rejection of claims. Yes, sometimes claims are rejected for no good reason at all. Who would have thought? The Healthcare Financial Management Association (HFMA) estimates that coding errors take place at a rate of 45-55% of the time and result in a 15% reduction in bottom-line revenue, 15%! Additionally, private insurers reject somewhere between 7-15% of all claims. If you’re dealing with Medicare, it gets worse—they reject about 22% of all claims.
Anyone who has spent time working with insurance claims knows there can be some serious obstacles that need to be climbed to achieve payments. What can you do to increase payments?
The first thing is to be vigilant at the time of patient registration. Collecting insurance information and checking on benefit eligibility is a step in the right direction, but this is only a small piece of the puzzle.
Timely filing is another part of the ongoing battle with insurance carriers. Some insurers require filing within 90 days of service or it will be rejected. C’est la vie. Once you get your claims filed in a timely manner, it is imperative to consistently and continually follow up on any and all rejected claims—for some insurance companies, the clock is still ticking; timely filing isn’t achieved until a correct claim is received. This effort will ensure that a small clerical error does not become a big error in the form of lost dollars.
We’ve discussed a few steps that can be taken to mitigate revenue that is lost from unpaid insurance claims. We have not touched on the area that may be most troublesome across the industry—the lack of manpower. In this day and age of budget-cuts and reduced workforce, there simply is not enough time in the day for many business offices to keep up with all denied insurance claims.
The good news is you are not alone out there. A competent 3rd party agency can assist you in crossing the often times treacherous waters of insurance claims collection. Whether you are having trouble with many phases of your process, or simply do not have the time to follow up on every claim, a 3rd party agency may be the resource you need to reduce that lost revenue. Another benefit of using a 3rd party is the fresh pair of fresh eyes that looks at your accounts and can pick up trending. Let’s say your billing department consistently makes the same error, believe it or not, this does happen. Catching a trending error like that can really accelerate your revenue cycle.
Let someone else help with rejected claims, and those countless calls to insurance companies. Utilizing a cost-efficient 3rd party can free up two of your most precious resources, time and money.
I know you may be saying, “Great, one more vendor…” The good news is that your collection agency may offer this as one of their services. Look into it; you may be surprised by the help that is available to you.