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How to Prevent Eligibility Rejections and Denials 

Sometimes, you may notice that your patient’s insurance provider rejects or denies your medical claim. This can occur due to a number of reasons, including incorrect or incomplete information. Fortunately, one study shows that healthcare providers can prevent around 90% of eligibility denials in medical billing. 

Given the financial and personal importance of medical billing, it’s essential to implement new practices to help prevent eligibility rejections and denials. That’s why we put together this guide to help you understand how to work on denials in medical billing. 

01 How To Reduce Eligibility Rejections And Denials

5 Ways to Prevent Insurance Denials

Eligibility denials in medical billing can cause many side effects, such as payment delays, reduced revenue and increased administrative costs. Here are five tips to help you prevent claim denials to get you started. 

1. Understand the Root Cause of Denials 

According to the Change Healthcare Index, half of denials occur due to issues in the front-end process. This means your front-end staff may be the root cause of the denials. By submitting incorrect information, you may have increased days sales outstanding (DSO), which slows down cash flow for your company. Be sure to regularly check in with patients to confirm their address and insurance information. 

Many people might move or switch jobs regularly. To ensure that you are always up-to-date with the most recent information and prevent claim denials, check in with your patients about these details if they come to your practice often. This step can help you save time and costs on verifying various information whenever insurance companies deny a medical claim. 

To simplify this process, you can leverage digital patient intake technology to collect accurate patient information which helps prevent claim denials and help you get paid faster. Offering a patient billing portal that offers a wide range of information for patients about how the insurance and billing process works can also be beneficial.

You can make denial statistics an ongoing part of your monthly team meetings. By regularly discussing the importance of denial prevention and general statistics versus your company’s denial statistics, employees will begin to realize its significance. To make an effective impact, you might set monthly goals for your staff to encourage workers to avoid mistakes that may lead to claim denials. 

Keeping track of your statistics by payer, doctor, procedure and department can also help you narrow down where your denials and rejections are coming from. This is a great way to help you evaluate whether there is a common solution you can apply to prevent these issues from occurring again. 

2. Train Staff on the Claims Process 

It is crucial to train and educate your staff about the claims process so they know their critical role in the process and how incorrect information can lead to denied claims. Training can help your staff understand which actions lead to incorrect information and teach them best practices going forward, ultimately helping you ensure accurate and complete information. 

Get them to understand the effects of denials and that denial prevention can result in more revenue for everyone, less work and patients who are happy with the service they received. Training your staff to check registration information for completeness, accuracy and consistency will make the process more well-organized and prevent claim denials for your company. 

As an additional tip, it’s best to address denial prevention in all stages of the revenue cycle, including: 

  • Case management 
  • Compliance 
  • Coding 
  • Medical records 
  • Patient accounting 
  • Patient access 
  • Contracting 

3. Verify Insurance Eligibility 

To prevent eligibility denials in medical billing, you need to make sure that your staff verifies insurance eligibility before sending a claim to the patient’s insurance provider. Some aspects they can verify include ensuring your patient’s plan covers the service you’re providing, the patient still has the same coverage and the bill is within their maximum benefit. 

To ensure your staff understands all aspects of what makes a claim eligible, allow them to familiarize themselves with the policies and how to interpret them, which plans you access and discuss coverage information with patients for clarity. Millennia’s real-time insurance eligibility tool automates the process of verifying insurance eligibility through digital engagement, reducing human error and increasing revenue. 

4. Collect Accurate and Complete Information 

Missing or inaccurate information makes up a large portion of denial write-offs and claim denials. To help prevent denials, it’s essential to include all the required information. Some areas that your staff might forget to complete include: 

  • Date of medical emergency 
  • Date of accident 
  • Date of onset 

Additionally, some critical information your staff should always double-check for accuracy include: 

  • Patient name 
  • Sex 
  • Date of birth 
  • Primary insurance 
  • Insurance payer 
  • Policy number 
  • Patient’s relationship to the insured 

A great way to ensure that your staff stays consistent is by handing out monthly reports with feedback on how well they did to include accurate and complete information and which aspects they need to focus on more for the following month. 

5. Invest in Technology From Pre-Arrival to Post-Visit

02 Invest In Technology From Pre Care To Post Care

With the correct technology, you can automate many of these tips to speed up the revenue cycle management process and prevent denial claims. By using digital health insurance eligibility software like Millennia Access, you can prevent human mistakes and denied claims from occurring because it takes away the need for manual processes. Millennia Access allows you to manage certain processes of the patient journey from pre-care to post-care. 

It automatically confirms if your patient’s insurance information is correct, unifies demographic information and content in a central platform and provides a patient payment estimation tool for accuracy and efficiency. This will help your team focus on core tasks while the software automatically takes care of verification, allowing you to save costs and increase customer satisfaction. 

Explore Millennia’s Insurance Eligibility to Help Your Practice Prevent Claim Denials

One of the easiest ways to prevent claim denials is by integrating an insurance eligibility software to help streamline specific aspects of the claims process. Millennia provides quality technology solutions that have improved payments and patient satisfaction scores for health care providers. 

To automate processes like confirming insurance eligibility and store all information in a central platform, Millennia Access is an excellent option. If you need a client portal for streamlining administrative tasks, Millennia Recover offers various benefits. For a combination of both, Millennia Complete is the ideal solution to prevent eligibility denials in medical billing. For a powerful digital solution, we encourage you to schedule a consultation with a member of our team. 

03 Explore Millennias Insurance Eligibility To Help Your Practice Prevent Claim Denials