Why Claim Denials Occur and How To Handle Them?

There could be multiple reasons at play as to why the claims are denied by insurance agencies. Some often common and easily dealt with while others might be a tad bit too hard to detect without the help of a certified professional at hand to assist. Here are few reasons you might encounter from time to time.

1. Mixed-up documents: Exemplifying a case where your chiropractor has submitted a claim for Chris Martyn, but you have been listed as Chris Martin at your insurance agency which guarantees the inevitable of a denial.

2. Many times a medical billing insurance agency might disagree with the medical practitioner about the treatments involved and required due to a variety of reasons, such as:

a)The requested test or treatment is really not required to be done.

b)The test is necessary, but you are unable to convince your insurance agent for that. In that case, you have to explain more about why you need that test or service to your insurance agent.

3. When your insurance agent wants you to give priority to a less expensive option, then he will probably approve the requested treatment if you go for the option that he expected you to choose, but it is not up to the mark.

4. The insurer will deny the claim if the service is rendered by that specific physician but approve if you opt a different physician for the same service. Or you can also try to convince your insurer that the opted physician is the only physician who can render this service.

5. Inadequate data entered with the claim or pre-authorization request will also lead to claim denial. Let's say you have requested subluxation of the cervical spine, but your chiropractor didn't fill any data regarding your spine.

6. You will need denial management in healthcare if you don't follow the insurance guidelines. As an illustration, let's consider that your insurance plan requires you to get pre-authorization prior to receiving a particular non-emergency treatment. But you have got that treatment without having pre-authorization from your insurance agent. In that case, your agent has all the powers to deny your claim just because you didn't follow the guidelines even if you really wanted that treatment to be done.

How to handle claim denials :

Be it a denial for the treatment you have already had or a denial in the pre-authorization request, getting a denial is always burdensome. You may assume your ineligibility of a specific treatment because of a denial during pre-authorization, but hey, think again!

A denial doesn't necessarily disqualify you to receive a specific treatment, it simply states that the insurance shall not cover it which disqualifies you to file for a claim but you can simply opt to pay for the very same from your own pocket.

All insurance plans avail the extra benefit of the 'Appeal process' in case of a denial. The process shall be summarized in the information you receive along with the denial of the claim or during pre-authorization.

However, after putting such efforts you are not able to resolve the issue by working internally the insurance plan, you may go for an alternate method i.e. external review of the claims denial. For this, you can outsource this service to a third party chiropractic billing company like Bikhamchiro.

To avoid tricky pastures and help you streamline your claim process Bikhamchiro offers you the option of outsourcing your Claim denial process. A team of certified professionals with vast experience shall take on your denial headaches and help you achieve exponential growth and success.  

To know more talk to our medical billing specialists or email. You can also visit our website Bikham dot com and follow us on Google Plus, Pinterest, Facebook, Twitter YouTube and LinkedIn for latest Medical Billing and Coding blog

Leverage Radiology Medical Billing Service to Take your Business to the Next Level

Radiology is the medical field that uses medical imaging techniques to diagnose and treat physical disorders. Radiologists analyze and interpret scans like MRI, X-Ray, PET scans etc. They also play the role of a consultant by recommending doctors to patients if more tests are needed. In the same breath, handling radiology medical billing along with the treatment can be perturbing and time-consuming.

Medical billing for radiology can be demanding because of numerous diagnostic and procedural codes involved in it. We, at Bikham are completely aware of the nature of your radiology practice. By outsourcing radiology medical billing services to us, you get a team which is always up-to-date with the changes in the healthcare system and has the ability to help you submit your claim, incur reimbursement quickly and augment cash flow.

Denial Management Services: The experts in our team are deft in managing and analyzing denials. Figuring out the reason for denials can help a lot to get them paid easily and avoiding further denials and revenue losses, simultaneously. If the reason for a denial is incorrect code, that can also be rectified by our medical billing team. We understand that the wrong codes can't be changed, but the codes that eligible for the reimbursement from the insurance can be put forward for the processing. Denials are needed to be treated carefully because almost 10% of revenue is lost due to ineffective denial management.

Final Verdict: Revenue management services of our medical billing team for radiology provide daily, weekly and monthly reports and hence, keep you updated about all the facets of your practice.

To know more talk to our medical billing specialists or email. You can also visit our website Bikham dot com and follow us on Google Plus, Pinterest, Facebook, Twitter YouTube and LinkedIn for latest Medical Billing and Coding blog.

Know the key steps involved in Medical Billing Insurance Claims Process

The Medical Billing Insurance Claims Process begins with the initial paperwork of patient’s insurance. Once that’s done, the next step involves the patient visit, where the doctor (also known as the provider in the medical billing term) diagnoses a patient and then documents all the services. This encounter of a patient with the provider then becomes billable, converting it into a claim and later submitted to the front office for Medical billing claims process.

The documentation or a medical report from the physician involves all the information that the physician feels is essential and relevant to the patient’s care such as, the reason for the appointment and admission, type of a procedure done, and any other essential information.

Nowadays, most of the providers are moving toward preparing documentation using electronic health record instead of conventional handwritten paper format. The information in an EHR is much easier to read and understand than handwriting. So, you need to enter all collected information at check-in as well as the doctor’s documentation related to the patient by using the correct CPT and ICD codes into the medical billing software.

Therefore, by taking into account of Medical Billing Insurance Claims Process, we are highlighting the following key steps:

Needful information regarding the patient is entered into medical billing software, including patient demographics, payer, and financial guarantor information.

Based on the physician’s documentation, the billable codes are entered.

Select the appropriate claim form in medical billing software, and then enter needful information using Current Procedural Terminology (CPT) codes.

Then the International Codes for Diseases ICD-10 (for the diagnosis) are appropriately entered and pointers assigned to the correlating CPT’s.

Before submitting the coded information, it is always better to have another teammate to double check the bill and review any coding or demographic errors to keep it as ‘clean’ as possible.

Finally, send the Medical billing claims off for processing.

In the Medical Billing Insurance Claims Process, medical bills are electronically uploaded to a medical clearinghouse and later sent to a suitable payer. But in few cases, claims can also be sent directly to the payer.

Should you consider Outsourcing your Medical Claims Billing?

If your practice gets stuck with any issue of Medical Billing Insurance Claims Process, you should definitely consider outsourcing Medical Claims Billing work to Bikham Healthcare.  Our experienced medical practice consultants & Billers are known for delivering world-class medical billing and coding services, especially in Medical Billing Insurance Claims Process.

Our qualified and skilled medical claims specialists provide end-to-end medical claims billing services to the healthcare practices of all specialties and sizes. They can develop outstanding efficiencies in the Medical Billing Insurance Claims Process and will also ensure a continuous growth in the revenue of your practice.

So look no further! Take your practice to new heights by partnering with one of the best and trusted medical billing & collection partner – Bikham Healthcare.

To know more talk to our medical billing specialists or email. You can also visit our website Bikham dot com and follow us on Google Plus, Pinterest, Facebook, Twitter YouTube and LinkedIn for latest Medical Billing and Coding blog.