Denied claims are more than just a nuisance. Time and time again you ask patients to update their insurance information, only to come back with another denied claim.
Rather than caving in to your frustrations, here are 5 simple tips that will help you reduce the chances of claims that are denied through your medical practice.
1. Call Insurance Agency Before The Patient’s First Appointment
This is one of the easiest ways for you to avoid getting denied claims. Before you see your new patients, ensure that you gather all of their information before the appointment. Once you have received their insurance information, call the number on file to verify their eligibility.
Some patients are unaware of just how far their insurance coverage goes, cancellations, or even changes to their insurance, so they may not be covered to receive care from you. By checking on their policy before you see them, it will help eliminate denied claims in the future.
2. Validate Information With Agents
While you are on the phone with your new patient’s insurance agency, be sure to match their information with yours. Verify the following:
- ID number
- Date of Birth
- Patient’s full name
- If the insurance is active
Patients often receive new insurance cards that have updated ID numbers and other information that may deny a claim if it is inaccurately reported. Even the slightest changes can keep you from getting payments on time.
3. Ensure That Their Policy Covers The Procedure
As mentioned before, many patients do not understand exactly what their insurance does and does not cover. No matter how minor or major the procedure, it is important to check back with their insurance provider to ensure that their policy covers it.
In order to look into their coverage, you will need both the CPT Code and the ICD-9 code. If the patient does not have preventative benefits, anything billed with these two codes will not be covered and will be processed as the patient’s responsibility.
4. Confirm Prior Authorizations or Referrals
Another question to ask the insurance provider is whether or not the procedure will need any special authorizations or referrals.
If your patient requires a referral to undergo a procedure with you, the referral will need to be redeemed from the primary caregiver.
If your patient needs a prior authorization, it will need to be obtained before they are seen in order for the claim and payment to be processed received.
5. Ask Patients to Make a Copy of Their Insurance Card
When your patient is cleared and ready for their procedure with you, ask to see a physical copy of their insurance card. Confirm that the information matches your records and ask to make a copy. By making a copy of their card, you will be able to check into their plan to ensure that it is active at their appointments.
If the information does not match, or the account appea