Denial Management: How to Reduce Costly Rejections

Highlights  

• Claims denial management is vital to the success of your chiropractic practice.

• Denial management involves assessing the root cause of denials and using a proactive approach to ensure proper submission. 

• Training your staff on chiropractic billing and coding can reduce claims denials.

• You can support your denial management strategy with fully integrated chiropractic EHR software with automated insurance processing.

Denial management is essential to improving your chiropractic practice’s insurance processing efficiency. Proactive denial management means fewer costly rejections, fewer resubmissions, and an improved patient experience.

By implementing actions such as pre-verifying insurance coverage, training your staff on proper coding, and using automated chiropractic practice management software, you can boost your cash flow for continued success.

Why is Denial Management Vital to Your Chiropractic Practice?

Insurance claims denials cost the healthcare industry millions of dollars each year. The Healthcare Financial Management Association reports $262 billion in denials for healthcare providers. Providers fail to resubmit nearly 65% of denials, leading to lost revenue and stifled cash flow.

Denial management is vital to your chiropractic practice to ensure you are reimbursed for patient services. 90% of claims denials can be prevented with proactive denial management strategies like verifying insurance before providing care and using practice management software designed to handle bulk insurance processing.

Using denial management tactics to reduce your claims denials can elevate your chiropractic business by streamlining multiple areas of your practice. Your biller can process claims more efficiently, freeing up time for other tasks. Your patients experience less uncertainty regarding payments, and your practice receives faster reimbursements and fewer denials that complicate processing and hamper your cash flow.

Denial Management Strategies

Denial management strategies for chiropractic practices include understanding why claims happen and how to prevent them. Rather than addressing denials after they happen through time-consuming claims resubmissions, you can take a proactive approach to prevent denials before they occur.

Verify Patient Identity and Insurance Coverage Before Providing Service

The Medical Group Management Association found that 42% of denials happen due to failure to obtain prior authorization for treatment. Your chiropractic staff needs to verify the patient’s identity and insurance information before providing care.

You can use a fully integrated chiropractic practice management system to verify patent information upfront, reducing your denied claims. With a system like ChiroTouch and its ancillary feature CT Verify, your staff can check patients’ insurance eligibility at check-in.

Along with verifying insurance and identity, train your staff to recognize the insurance plans you do and do not accept. For example, if your practice isn’t enrolled in Medicaid, you must charge the patient upfront for services to ensure you are paid.

Communicate With Patients About Their Payment Responsibilities

With the implementation of the No Surprises Act in January 2022, it’s more important than ever to have clear, direct communication with patients regarding their payment responsibility. Advisory Board suggests providing a pre-service bill before providing care to a patient and obtaining 60% of their obligation on the day they receive treatment.

After verifying your patients’ information and insurance, provide them with a printed document with their projected responsibility. Go over this with your patient before you treat them to ensure you don’t run into claims denials later. Offer your patients an easy way to pay their portion by using chiropractic practice management software that allows for credit card and online payments.

Train Your Staff in Proper Coding

Improper coding can lead to costly claims denials and resubmissions. On average, it costs $25 to resubmit an insurance claim, and when combined with the time it takes your biller to process the issue, you pay many times over. You can prevent claims issues by training your staff in proper chiropractic coding.

Use resources like helpful billing and coding webinars from industry professionals for tips and hints on prevenient denials. You can also help your staff by using a chiropractic EHR that automates the insurance process with a coding engine and practice-wide synching capabilities.

ChiroTouch users can take advantage of CT PRoClear, an ancillary service that tracks all your claims in one tool for a claims acceptance rate of 98.06%.

Submit Claims on Time

Submitting your claims on time can significantly affect your reimbursement rate. 7% of those surveyed by MGMA reported that untimely filing leads to increased denials. When handling chiropractic billing and insurance processing, you must submit your claims as soon as possible. Timely submission reduces the chances of denial due to lapses in coverage and improves your practice’s cash flow.

An automated practice management system helps simplify the process and syncs information from the provider’s EHR screen to the insurance claim form. With easy-to-use templates, your biller can submit timely claims to see quick reimbursement.

Maintain Proper Documentation

Third-party payers, specifically Medicare and Medicaid, won’t approve your claim without high-level documentation compliant with their regulations. For example, if you use the wrong code or fail to document that a procedure is medically necessary, these payers will likely reject your claim.

Implement a process for maintaining proper documents that are compliant with HIPAA and insurance carrier requirements. Opt for a practice management system with touchscreen capabilities and customizable macros to document your procedures accurately and apply the right insurance codes at the time of treatment.

Use an Updated, Cloud-Based Practice Management System

The best way to reduce claims denials is to use an updated, cloud-based practice management system design for chiropractors. ChiroTouch is a completely integrated chiropractic EHR practice management system that allows you to streamline all aspects of your practice for increased efficiency and better patient care.

With ChiroTouch, you benefit from seamless data integration, access to insurance clearinghouses, and synching capabilities that simplify insurance processing. With accurate coding and insurance processing, you will experience fewer claims denials and increase your cash flow predictability.

To learn more about the many ways ChiroTouch Advanced can make claims management easier for insurance practices, download our free eBook, How ChiroTouch Integrated Chiropractic EHR Simplifies Insurance.

Use ChiroTouch as Part of Your Denial Management Strategy

Using the right chiropractic EHR practice management system can support your denial management efforts. ChiroTouch uses data integration for fewer coding errors and works with an automated insurance clearinghouse for faster, more efficient claims processing to reduce claim denials and boost your practice’s cash flow.

Schedule your demo today to learn how ChiroTouch’s chiropractic-centered practice management system can streamline your insurance claims process and increase the efficiency of your practice.

Material for this article was drawn from the webinar Billing and Coding Hints and Tips: Say Goodbye to Senseless Denials. Our thanks go to Yvette Noel from KMC University.