03/04/2022
Healthcare industry sources estimate that approximately 50% of claim denials are never reworked. Lack of time and knowledge are cited as primary reasons. One or two denials may seem immaterial, but they can add up quickly. The average cost to rework a claim is $25 and about 9% of claims are denied after initial submission. Thus, at a claim volume of 1,000 per month, denied claims cost $2,250/mo. and $27,000/yr.
Claim Volume / Month: 1,000
Denied Claims (9%): 90
Reworked Claim Cost: $25
(90 claims/mo. @ $25 each)
• Monthly $2,250
• Annually $27,000
Things to watch for that may help your practice reduce denied claims include the following:
Patient Information is changing more frequently - Is your EHR and/or practice management software set up with the correct patient, payer, and provider information? Better software programs check eligibility automatically, but with COVID and the Great Resignation patients are changing employers and thus payers more often. So, to follow best practices, front office team members should check this information at the time of the initial as well as follow-up visit.
Ensure correct provider information - Once provider setup is complete there is customarily no need for frequent changes. However, it may require daily attention if a doctor bills, for example, as a general practitioner as well as a specialist. It’s also important to check regularly when a practice has multiple locations and/or providers requiring that claims are matched correctly. Additionally, it’s important to verify referring provider information is included when needed.
Bottom Line Consulting: Expert Medical Billing & Consulting
