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Insurance Claim Denials and Tips to Avoid Them

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Insurance Claim Denial Management is an essential part of the Revenue Cycle Management Process – and can have long term effects on the financial health of your practice if not managed correctly. Logik provides a complete billing solution, including insurance denial claim management – and we can help you collect the full amounts owed to you, and take the stress out of the process.

Read more about how Logik can help save you and your billing staff time for those projects you have been wanting to complete, and some key solutions for insurance denial claim management that will aid you in being able to focus more on patient care.

Denied claims usually fall in to three main categories including policy, clinical, or administrative denials. Let’s look at some common reasons for claim denials, and some key solutions that might help you and your billing staff. Some denials are not repairable, meaning the practice will never be able to get money for the claim they submitted.  A practice management system that guards against those types of denials is key. 

1. Lack of Pre-Authorization

If you as the provider fail to get prior authorization, you may miss that the patient is ineligible for services, a health coverage plan has ended or perhaps the insurer just will not cover the cost of treatment. The patient would then bear the cost or cancel their appointment – meaning you might not get paid.

Tip: Read more about the importance of prior authorizations and how Logik can help!

2. Errors with Patient Information

Similar to #1, any errors with patient information submitted to insurance will cause a claim to be denied – even just one field being incorrect.

3. It’s Past the Filing Deadline

Each insurance carrier has their own guidelines for how long you have to submit a claim. Some are only 30 days from the date of service.

4. Lack of Quality Documentation

The clearer and more detailed your documentation is, the less likely you’ll need to answer questions or face drawn out reimbursement processes. Documentation should be correct, complete, and legible. 

5. Incorrect Coding

Accurate coding is essential if a clinician wants to receive reimbursement. When coding errors occur, they can result in claim rejections and payment delays. If errors seem persistent or unusual, a practice may even be audited or charged for fraud.

  • Refer to the AMA’s most recent CPT manual to ensure correct code usage
  • Check and recheck work
  • Read notes attached to codes
  • Familiarize your team with popular modifiers that may cause claim denials

6. Exceeding the Authorized Units of Service

If a practice provides a service, but the patient has already exceeded their number of authorized units of service, the practice can’t get paid for those services. 

Using an integrated billing solution can help eliminate these errors, since information flows through the system, it will be updated in every module. Additionally, working with a dedicated denial management expert ensures you stay on top of these deadlines and requirements – it is their job to help you stay on top of insurance regulations and keep you and your team up to date with any changes.

How Logik Can Help

As discussed earlier in this blog, dealing with insurance claims can be complicated – especially when each patient has a different list of services that must be invoiced. An effective, complete billing solution like Logik can help determine if visits are billable or nonbillable, as well as assist in developing plans to get you paid. In other words, focus on what you do best, provide exceptional service. Let us handle the rest.

Tip: We don’t have to replace your biller or billing staff. We can keep things moving when:

  • Your billing staff is out on vacation, sick, etc.  
  • Overturn in billing staff 

Our goal is to help you by ensuring correct claims are going out the door, and the highest collections possible are coming in with no disruption to your cash flow or patient services. 

 Discover how we can save you time (and help reduce lost revenue) today!

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