2 min read

5 Ways to Break up with Repeat Denials

Featured Image

Roses are red, denials are blue, a break up with repeats for Valentine's Day is easy to do.

Let's face it. Healthcare organizations around the country seem to have a love hate relationship with repeat denials. Most healthcare providers don't explode with warm and fuzzies when they see repeat denials, yet they're unable to break the cycle. Or worse yet, they don’t believe it’s even possible to live without denials because it’s such a normal part of our day-to-day operations. The truth is, most denials could be prevented with improved processes, increased training, and proper system edits.

Healthcare providers experience repeat denied claims for a variety of reasons (additional information needed, exceeds frequency, benefits exhausted, coding, timely filing, medical necessity, etc.). Repeat denials soak up valuable time and resources in your healthcare organization, but more importantly, slow down your cash flow. Break the cycle with these five repeat denials.

Most common repeat denials you should break up with today.

  1. Incorrect Insurance Information
    This may seem like a no-brainer but too many claims are denied due to incorrect insurance information. Love is in the details! Pre-registration should take the extra time to verify all of the patient's information including insurance, leaving both of you feeling the love when all of the information is complete and accurate.

  2. Duplicate Claims
    Think of duplicate claims like receiving not one but TWO unwanted Valentines. Duplicate claims can easily be prevented by using a claim scrubber, which checks for conflicting claims based on the date of service and edits for accurate billing information on corrected claims. Allowing duplicate claims to go out the door significantly increases your time to get paid. These are definitely not cheaper by the dozen.

  3. Workers' Compensation
    Our best advice is to wait until the Workers' Compensation claim has been verified 100% before submitting to insurance. Healthcare providers should never send workers compensation claims to the employer – EVER. Employers are not covered entities and sending PHI to them would be a breach.  If the patient is unable to provide the Workers’ Compensation carrier at the time of service, register them with the health insurance or make it self-pay until provided.

  4. No Authorization
    Certain procedures like MRIs and CT scans require pre-authorization. Failing to get an authorization will result in a denied claim, a not so lovely way of saying won't get paid for a service. Passing the cost off to the patient is unprofessional. Best practice: communicate and train staff on the correct process to obtain an authorization before the service and increase your chances of the claim will be paid. Include clauses in your contract to allow for retro-authorization in cases where services were medically necessary. 

  5. Coordination of Benefits (COB)
    When patients are double-dating healthcare plans, make sure your registration staff is well trained in the COB rules. Provide prompts and edits to prevent errors such as:  Medicaid should be the payer of last resort, Medicare should not be primary when liability is involved, birthday rule edits when appropriate, etc.

For more information on our formula to eliminate repeat denials, see efficientc.

Subscribe to Healthcare Revenue Cycle Blog

There's nothing sweeter than eliminating denials to sweep a healthcare provider off her (or his) feet. It's easier than brewing up a batch of love potion #9.