3 Reasons Patient Claim Denials Keep Making You Crazy

There’s a special place in hell reserved for incomplete patient claim denials.

You know the ones—stress-inducing, revenue-compromising, how-the-BLEEP-could-they-forget-to-mention-their-history-of-blood-clots denials that cause you and your organization to sacrifice a lot of money. Millions of dollars in claim denials can build up quickly and if you don’t implement a strategy to reduce and manage your denials, you’re leaving a significant amount of revenue on the table.

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Missing patient info claim denials should make you angry, because they’re stealing time and money from your organization (and that’s not cool folks, not cool at all).

But, before you can devise a plan to manage insurance denials, you have to understand why they happen in the first place.

  1. Many Denials Are Caused By Missing Information

For claim denials, all it takes is a missing field or misinformation to bring the entire process to a screeching halt. Missing information on vital queries are fairly commonplace reasons for denying your claim and insurance companies aren’t exactly chomping at the bit to pay you what you’re owed—especially if they have to work for it. Reasons include:

  • Coordination of Benefits (COB)

  • PIP Applications

  • Accident Details

  • Pre-existing Conditions

  • Name Misspellings

  1. Carriers Aren’t Trained to Properly Communicate Or Manage Denials

Many insurance agents aren’t adequately trained in customer service or patient satisfaction practices. In fact, commercial insurance agents inaccurately process over 20% of all medical claims. Educating agents on how to avoid these problems from the start is clearly a necessary step in the process, but unfortunately, it’s not necessarily their top priority.

CFOs and hospital executives who are fed up with these inefficiencies are actively researching and implementing the top solutions available, like outsourced BPO and revenue cycle services who are focused on both lowering claim denials AND providing patients with exceptional customer service.

  1. Denials Create More Work and Cause More Internal Friction

Sorting through hundreds of denied claims that were supposed to be completed months ago is great way to drive your team insane, regardless of how imperative they are to address. Denied claims take twice as long for approval, plus the constant communications back and forth between you and the insurance carrier inevitably take time (and focus) away from more profitable activities.

And on top of that, missing patient information is just ONE claim denial reason you’re dealing with. Don’t forget about:

  • Increase in Insurance Complexity

  • Claim Isn’t Specific Enough

  • Missing Patient Demos

  • Missing Insurance Eligibility

  • Claim Wasn’t Filed In Time

  • Unique Authorization Requirements

  • Medicare Reductions/Revisions

  • Switching Insurance Coverage

If you have the manpower to devote to managing your denials, that’s great—but more often than not, hospitals and large healthcare practices don’t have the appropriate team (or time!) to handle such an undertaking. After all, you need the necessary funds for resources, salaries, phone bills… it all adds up. That’s why outsourcing denial management makes so much sense, but fear not! You're claim denial management heroes are just around the corner.

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Healthcare BPO Companies and Denial Management Solutions To The Rescue

If managing your patient claim denial process is something you want to handle internally, there’s a lot of work ahead. But if you have a headache just thinking about an in-house strategy, there are plenty of reputable and proven 3rd party  denial management services available to help hospitals like yours recoup millions of dollars in denied claims. These healthcare Business Process Outsourcing (BPO) Companies do all the work for you so you can focus on the strategic and high level necessities of the organization.

The top BPO companies bring in maximum collections from patients and payers while providing an exceptional customer service experience that motivates patient retention. They’re experts with significant negotiation training and insurance experience- and they get you paid quickly.

To learn more about VARO Healthcare solutions for combatting denied claims, like our fast-growing PIN service, contact us for a complimentary evaluation and trial. 

Determine If You Need Denial Management Services

Topics: Patient Denial Management

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