Medical Practice: 7 Steps to Lower the Percentage of Claims Denied

Many people are struggling financially as a result of the economy’s current status, which has seen an increase in unemployment and the closure of several businesses in the aftermath of the worldwide coronavirus epidemic. Similarly vulnerable to pandemic-related downturns are healthcare medical practice.

Therefore, in light of the rising number of denied claims, it is sense to make an attempt to lower them in order to preserve your organization’s financial stability.

After all, according to the Medical Group Management Association, an estimated 69% of healthcare executives have noticed an increase in rejections in 2021. At least half of the leaders who reported an increase in denials stated it was up to 10%, and 12% said it was as high as 30%. Any healthcare professional would be concerned by these figures, which would make them look for a remedy.

For practices of all sizes, from small single-family practices to big multi-specialty groups, tackling out-of-control rejected claims volume is advantageous. With these 7 steps, your practice’s denial rate will decrease.

1. Confirm patient data upfront

Some healthcare facilities simply do not have the time to examine important patient information because they are overworked or overloaded with patients. However, this can be a prescription for financial ruin. You should underline the significance of lowering claim denials. The majority of denials, according to 42% of healthcare professionals who spoke with the MGMA, were due to previous authorization.

Train your staff to obtain this crucial data as soon as possible, such as when making an appointment or during check-in time for a patient. By automating this procedure rather than having employees manually call providers for each question to confirm each patient’s insurance status, you may save time. Regardless of how you do this work, you must continue to perform it regularly.

2. Point out the patients’ obligations

Failure to adequately explain the specifics of what your patients are liable for might be one issue. A sign in the lobby is an excellent place to start. A standard document that patients must sign acknowledging that they have been advised of their financial obligations can also be included.

Posting this information on your websites and adding it in an article in the newsletter you send your patients on a recurring basis are other strategies to distribute it.

3. Refresh Staff Onboarding and Training

Sometimes a lack of continuous (or enough) employee training causes cracks to form in an organization. Start by gathering your employees and reminding them that the diagnosis and treatments you provide must be supported by the necessary clinical paperwork. Changes to the care must be noticed and supported, for example, by supplying the codes to enable longer patient stays or a specific treatment approach.

Make improving staff accuracy in medical coding a priority. They might require the training to stay current. Your recruiting, onboarding, and recruitment processes for employees should take into account all of these issues.

Ensure your claim submission, coding, and the documentation should meet the insurance guidelines with the help of coders who can provide the medical coding services to your medical practice.

4. Send in claims as soon as possible

According to MGMA’s research, 7% of the healthcare professionals polled said that timely filing problems were the primary reason for refused claims. Any medical team can quickly and simply fix this. Send in a group of claims at once and on time. Determine the cause of some of the delays. Was it a mistake? Are your employees so busy that they are unable to meet the deadlines for filing and delivering claims? To improve the responsiveness of your company, identify the primary causes of delays.

5. Employ Professionals to Conduct an Audit

An organization may find it challenging to see itself objectively. You might not have the knowledge to recognize that your team’s claims and billing processes need to be improved. Although the office appears to be running smoothly on the surface, there may be some issues due to a knowledge gap, such as in medical codes. You could only need the assistance of consultants performing a medical code audit to get things back on track with your team.

6.System Upgrades for Computers

Your computer system probably hasn’t received an update in a while. Medical offices place a high priority on minimizing risk, therefore managers may be concerned about downtime while changing a computer network, installing the most recent version of the operating system, and installing essential applications. However, a more up-to-date computer system enables your personnel to perform more quickly and productively. Additionally, it offers you the most recent security safeguards and enables you to use specific claims denial management software.

7. Utilize applications created for managing denied claims

Don’t try to get by with organizing and processing claims in a generic computer program before submitting them to insurers. Utilize a comprehensive software program to handle rejected claims. Your team’s refused claims will be shown, along with the justification for not paying. Then, you immediately resubmit the claim after using the program to make any required adjustments

Reduce the Number of Rejected Claims as a Priority

Your organization’s income flow will significantly change if you focus on reducing the percentage of claims that are refused. If fewer claims are denied, your budget may have more leeway, allowing you to hire more personnel or make equipment changes that will help the clinic and the patients you serve even more. View our educational video on claims denial management right now to gain a better idea of how it will operate in your business.

Key Points

  • It’s more crucial than ever for medical organizations to lower the amount of refused claims since consumers are under more financial strain.
  • Healthcare executives predict an increase in refused claims in 2021 by at least 69%.
  • Before you diagnose and treat patients, make sure your team checks their insurance status.
  • Patients should be reminded of their financial obligations to prevent misunderstanding or late payments.
  • In order to correct mistakes that might result in denied claims, retrain personnel as necessary, and enhance staff onboarding.
  • Utilize specialized claims denial management software to increase productivity and cash flow.

Managed Healthcare Denials and Rejected Claims

Claims that have been determined to be invalid are not paid for by payers. For healthcare organizations, both rejected and denied claims are a major burden since they result in lost or delayed income and a protracted appeals process.  

These teams look into the reasons why claims are refused, fix any issues, resubmit requests to insurance providers, and file any necessary appeals. The lack of this facility, however, in many medical practices calls for the use of healthcare denial management strategies.


Maintaining the reputation of a medical practice by giving each patient great care and treatment is a challenge in and of itself. Yes, medical practices help those who are in physical or emotional pain, but all businesses need money to stay in business and provide their services effectively.

In addition to the initial patient payment, claims have a substantial influence on the revenue cycle of a medical practice.

However, a large fraction of claims are denied each year, which results in a sizable financial loss for the practice. The causes can include giving inaccurate information, filing a grievance a significant length of time after the service has been delivered, filing a claim under an insurance policy that has run out of coverage, etc. Therefore, having a cohesive denial management plan is essential.

Connect with medical practice consulting services to streamline your medical practice from starting step onwards.

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