Your Guide to Reducing Claim Rejection Rates

Arun Joseph VargheseArun Joseph Varghese on August 8, 2021

Claim rejection rates can be a serious issue for healthcare providers. You will need to submit all of your claims correctly and on time, otherwise, you end up with productivity loss working on claim resubmissions and possible revenue loss. The best way to avoid this is by using hospital management software that is specifically created for healthcare professionals. With these tools, it becomes much easier to make sure that every claim is submitted in the correct format and includes all necessary information. Here is a guide on how you can significantly reduce claim rejections.

Having an accurate understanding of key requirements

It is important to have a clear understanding of the requirements that you need to fulfill for eligibility. The healthcare provider has to gather all the required data that proves the patient’s eligibility for insurance.

Another factor that needs clarification is the exclusions. Insurance companies do not provide full coverage for the patients and this is where clarity in understanding of services that are excluded comes into play. The healthcare provider has to understand the patient’s insurance schemes and the excluded services to avoid rejections.

Acquiring prior authorization from the insurance company is something you need to follow so that you don’t have to face claim rejections when submitted. Tracking prior authorization request status to billing orders is also a practice that reduces claim rejections.

Highlighting warnings and errors

Highlighting warnings and errors which are obtained through audit trails and resolving them is a practice that helps the process of claim submissions to be completed more accurately and also to ensure that the errors are amended before resubmissions.

Reducing administrative errors

Hospital management software can help healthcare providers reduce claim rejection rates. By carefully limiting or removing all possible human errors, the risk of claims being rejected is lessened.

The data provided on patient insurance details such as policy no/member ID, prior authorization, government ID details, and attaching necessary patient documents are some of the areas where an error can happen at the cost of a rejected insurance claim. The staff collecting these data need to be trained and aware of the importance of each documented data. 

Reducing pricing errors 

This also helps to reduce the claim rejection rate to a great extent. The recent shift from a manual process to the use of clinical billing software has increased accurate data recording and in accessing references to the latest information.

Using third-party cross-coding software 

To ensure high-quality claim submission and adherence as per complex rules and regulations, healthcare providers can rely on third-party cross-coding software. They conduct reverse searches on diagnostic to procedure codes to ensure accuracy. By submitting all reports to the insurance company through third-party software, you can ensure that they are sending in claims with accurate information. The hospital management system offers integration with these third-party insurance aggregators. 

When a major portion of the revenue in a healthcare provider comes by way of the insurance claims, it is very important to take extra care to improve claim submission using the efficiency of claim management software or insurance submission software. 

Investing in good hospital management software that can take care of your billing, claim submissions, insurance management, and revenue cycle management as well as integrate to third-party insurance aggregators is a wise decision to ensure complete sealing of any revenue leakage during the reimbursement process.

Insta by Practo offers coder claim review features to ensure tracking of changes and liaising of changes between the medical coder, clinician, and administrative staff, claim history tracking, claim management, batch creation, denial management, resubmission batch management by correction, or internal complaint and much more through its hospital management software.

Book now for a free demo!

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August 8, 2021


August 8, 2021