Claim denials can be frustrating, especially when you know that you’ve done your part in providing the right kind of care. However, healthcare providers make several common mistakes that often result in claims getting denied by insurance companies – and you might be making some of them yourself! Over 20% of all claims are denied or partially denied because of reasons that could have been avoided if proper attention had been paid to policy information during the policy-purchasing process. To help you avoid common mistakes resulting in claim denials, here are some things to keep in mind as you go through the purchase process.
Anytime you file a claim, you must fill out every required field. This includes your policy number, your claimant name, contact information, and any other relevant details. If you leave fields blank or submit inaccurate information, there’s a good chance your claim will be denied and will have to be resubmitted. The same holds for missing documents; if any are required by your insurer—such as photos of damage or receipts for services—make sure they’re attached. In some cases, missing documents could result in additional denial-related fees. Your insurer may also deny claims based on incomplete documentation of damages so take care when filling out forms that involve estimation.
Make sure your professional liability claim is filed on time. Failure to file a claim on time can be catastrophic for your business, which means it’s something you should pay attention to. A late filing will cost you $100 or more; at worst, it could mean disaster for your business and affect its ability to provide future services. Make sure that you understand when claims need to be filed and that you’re submitting claims promptly. There are different deadlines depending on whether there was a death or serious injury involved—be sure you know how these dates change with each incident. If all else fails, speak with an expert in Denial Management about amending missed deadlines or seeking compensation for damages caused by late submissions.
It’s important to take action as soon as possible after an injury or illness occurs. If you wait too long, your insurance company may see that you are in good health and conclude that your injury was not a covered occurrence. Non-specific claims refer to injuries with long onset periods that may result from cumulative stress on your body. For example, a broken hand suffered while throwing a party might not be considered a non-specific claim if it is caught early and requires little treatment. But what about two months later, when surgery is needed?
Anyone submitting a claim for reimbursement should always submit an accurate claim with complete information about all medical treatments received. However, in addition to submitting an accurate claim containing everything a carrier would need to process it properly, it’s important not to make mistakes that can make your claims more likely to be denied. It doesn’t matter if your handwriting is so bad that you have a hard time deciphering it – you should still go through extra efforts (or ask someone else) if necessary so that your insurance company has no excuse but to pay you as quickly as possible after performing its due diligence.
No matter how good your medical treatment is, you won’t get paid if it doesn’t meet an insurance company’s standards. For example, according to one insurer’s pay or play policy, there must be a 10 percent or greater difference between your charges and a set level of service. If you submit claims for a treatment that falls below that standard, you won’t get paid even one penny. Or, if your practice does not have a 100 percent clean compliance record (no issues with billing for seven years), don’t assume it’s okay; some payers will reject claims outright based on just one issue in the past.