Minimize Claim Denials with Clean Claims and Proactive Processes
Claims denials can drain time and revenue from your practice if not proactively managed. Filing a clean, error-free claim the first time is the most effective way to avoid delays and lost income.
Even small mistakes - such as incorrect patient information, missing modifiers, or inaccurate codes - can lead to rejection. The more manual your process, the greater the opportunity for errors during data entry, from patient check-in to claim submission.
Health insurers require “clean claims,” so it’s essential to have systems in place, like claim-scrubbing software or billing services, to catch errors before submission. Every claim should be reviewed to ensure:
- Accurate patient demographics and insurance details
- Correct CPT, ICD-10, and modifier codes
- Proper physician information (name, NPI)
- Complete documentation, including referrals and surgical notes
Track and Analyze Denials
Monitoring denials by reason code and payer helps uncover patterns - whether due to coding errors, technical issues, or changes in coverage policies. A proactive approach enables your team to resubmit quickly, appeal when needed, and adjust to shifting reimbursement rules (e.g., denials based on “not medically necessary” determinations).
Even with improved payer practices and technology, accurate and efficient claims management remains critical to protecting your revenue and maintaining strong patient relationships.