Reducing Administrative Strain from Claim Denials in Healthcare

Administrative burdens are not just centered around healthcare regulations and compliance. There can be many administrative burdens related to medical billing, too. This video reviews some growing trends in healthcare and provides insight into ways to handle them.
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Hi there! My name is Jennifer. Over the last 15 years, I've gained much experience working in the medical field in various roles. Through my experience, I've seen many medical practice owners make mistakes in running their businesses. That's why I created this channel - to help medical practice owners avoid these common pitfalls. I aim to promote growth and success within the private practice world of medicine. Healthcare has become too standardized, creating many unnecessary challenges and demands.
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[@barbm1634]

I agree, the insurance companies are purposefully delaying payment. Our practice is experiencing denials by a certain Medicare Advantage company that has not updated their system with the Medicare guideline changes for the global period made over a year ago. Also, NDC#s for FDA approved drugs waiting for codes are not processed correctly. Customer Service Rep takes the notes then send claim back for review, the result is same denial. Are these claims being reviewed or just sent back into the claims processing system? A provider relation rep is now a thing of the past. It is a struggle.

[@navigatingthebusinessofmed8251]

I’m sorry to hear this, but unfortunately it is a reality anymore. I wish you the best and thank you for watching and commenting!

[@Anubis0680]

Given these challenges when it comes to claim denials/delays how can a practice that is either just getting started or has been in business for a while create predictable month to month cash flow?

[@navigatingthebusinessofmed8251]

Hi there and thanks for watching! This can be challenging depending on your payer mix and also your specialty. A good goal is to have a set number of “preventive” type visits each month as those tend to not go to patient responsibility and insurance pays. Of course, the patient would need to be due for such services per their plan benefits and based on the last time they had a similar visit or are age appropriate. More than anything, sending out clean claims the first time and following your payer guidelines is going to be key to successful cash flow in the practice. This also means checking patient’s benefits and eligibility before patients are seen too. This will ensure you’re participating with their insurance and you can collect any copays at time of service. If you choose to do a deposit for patients with high-deductible plans, this allows for some financial stability too. Practices just need to have very rigid guidelines and check payer contracts that it is okay to that for their beneficiaries. I hope this helps- I could talk all day on this and I think I found a topic for a future video! Thanks so much!!

[@Anubis0680]

@@navigatingthebusinessofmed8251 Thank you! Does this apply to the traditional fee for service environment or would this apply just as equally under a value based care bundled payment option ?

[@navigatingthebusinessofmed8251]

@@Anubis0680 this would mostly be for FFS model since quantity plays a major factor. However, coding and submitting clean claims still apply for both VBC and FFS. VBC sees more bundling of services for set fees so this would make it a bit easier to have goals and anticipate monthly income.