Not all insurance claims that are submitted to insurance carriers are paid on the first submission. This is one of the reasons that we always say “Medical billing is much more than a data entry position.” A certain percentage of submitted claims will be denied. That percentage will vary depending on the office submitting the claims.
Offices with good billing systems in place will have a lower percentage of denials. Also, having a good system for patient verification will also help reduce the number of denials. Lowering the amount of denials on initial claims is good, but it is also important to make sure that any denials are handled quickly to prevent loss of revenue.
One thing that tends to get overlooked when handling denials is to check for other outstanding claims on a patient when a denial is received that will affect all claims out on a patient. For example, if a denial is received for a patient because the patient’s insurance has changed then all claims submitted for that patient after the change of insurance will need to be corrected.
Many times a biller will receive a denial for one particular date of service, make the correction and resubmit just that claim. They don’t take the time to look and see if there are any other claims out for the patient that also need correcting. As I’m writing this I’m thinking it would be a no brainer, but in all of my years of training this is actually something that needs to be taught especially with new or inexperienced billers. They just don’t think about the whole picture without being taught to.
We also teach them to look at the other family members as well. If the insurance changed for one of the children and the policy is through the parent, it most likely changed for everybody in the family. Looking into it now can save much work later on and even prevent money from being lost.
If the denial is for something that is only specifically related to the claim in question then this is not an issue. But if the denial is for something that would affect all claims for the patient and/or family, then it is important that the biller take the time to make sure all claims are corrected and resubmitted and not just the one that received the denial.
For more information on Handling Denials see our online course:
Reading EOBs, Handling Denials & Filing Appeals Course