Actionable Tips for Reducing Claim Rejections: #KareoChat Recap

Medical billing is a critical factor in determining whether a practice is financially successful. Claim rejections have a huge impact on cash flow. Working to develop denial management processes, allows for the opportunity to submit “clean” claims make the process smoother for all involved.

In a recent #KareoChat (first and third Thursdays at 9 a.m. Pacific/ 12 p.m. Eastern), participants joined host Manny Oliverez (@Capture_Billing),CEO of Capture Billing, a medical billing company that works with dozens of physician’s practices. They provide medical billing services and practice management advice for several specialties. (See Manny's blog post and slideshare presentation on the same topic: 9 Actionable Tips for Reducing Claim Rejections.)

In this chat, participants discussed actionable takeaways to help billers reduce claim rejections, and keep practice cash flow steady.

Let’s dive into the discussion:

Topic 1: What is the Difference Between a Rejected Claim and a Denied Claim?

It is important to know the difference between a rejected and denied claim when handling billing for a practice. Manny dove right in to answer the first question.

A rejected claim is a claim that never actually makes it to the insurance company and is never processed #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

A denied claim is one that is received and processed by insurance but does not actually get paid #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

This tweet summed it up nicely:

Rejected = Patient or Billing dropped the ball
Denied = No pay for you until you appeal it#KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Topic 2: What Causes a Claim to be Rejected?

A medical bill makes several stops before being submitted. Errors can occur anywhere along the way. Here are just a few reasons a claim may be rejected.

The most common claims rejections include incorrect patient demographics, incorrect coding, incorrect place of service, out of date information, duplicate claims and eligibility #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Claims can be rejected when the patient does not update their demographic information or provides the wrong information #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Wrong information can include old insurance information, incorrect date of birth, or if a form is not completed properly #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Sometimes we make data entry errors, like a transposed ID number which can easily cause a claim to reject. #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

denial may be due to prior auth reguirements as well #kareochat

— Dr. Tom Giannulli (@drtom_kareo) June 21, 2018

Claims can also be rejected immediately when CPT codes and ICD-10 codes don't match. For example a baby well check for a 25 yr old #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Topic 3: How Can you Reduce Claim Rejections?

As with all processes, constant improvement is imperative. Fortunately, practice team members and patients can take steps to help reduce claim rejections.

Here is a way patients can help.

Patients can help us by making sure we have complete information by providing us with the most current insurance card and demographics #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

These are ways good electronic claims submission software assist the process.

Sometimes the practice management software will catch simple mistakes that can be correctly immediately, before sending it to the clearinghouse. Kareo does this #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Good practice management software will check eligibility and help us catch data entry errors like a transposed number in a patient's id #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Topic 4: Why Do Some Practices Have Claim Rejection Problems?

Next, the chatters discussed reasons practices may face challenges with claim rejections.

Some practices have a claims rejection problem because they may not have the proper procedures in place for patient demographic intake. We see this all the time, patients get tired of filling out these forms over and over #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Poor training, inexperienced staff, overworked front desk - these are all things that might contribute to claim rejections #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Topic 5: What Features Should You Require in Billing Software that can Help Reduce Rejected Claims?

Armed with this information, chatters discussed billing software features that can help reduce rejected claims and help the billing process run smoother.

The features in billing software that you should look for include eligibility, coding assistance, pre-scrubbing of claims, and should be easy to use #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

EHRs do help tremendously - HOWEVER - they have to be set up and used properly #KareoChat

— Capture Billing (@Capture_Billing) June 21, 2018

Excellent advice, @Capture_Billing - Take the time to set up your system and plan for a review of processes on a regular basis. #KareoChat https://t.co/xaCslQgqzT

— Kareo (@GoKareo) June 21, 2018

This was a great discussion with so many actionable takeaways for those working to make their practice billing a smooth process.

And as always, join us every first and third Thursday at 9 a.m. Pacific time @GoKareo #KareoChat to talk about critical topics facing independent practices and the patients they serve.