Doubling Down on Denials: How to Get Paid the First Time, Every Time

As a rehab therapy expert, you know patient progression and improved function are clear indicators that your course of treatment is working. So, it’s disheartening—to put it mildly—when you send off your claim to the insurance payer for reimbursement, only to have it bounce back with a denial. In a perfect world, every service we, as therapists, perform would be reimbursed—and each claim we send would be accepted the first time. Unfortunately, denials have become a hard fact of life in the healthcare industry. But that doesn’t mean we can’t prevent many of those denied claims from happening in the first place.

Preventative policies keep denials at bay.

When you’re talking about claim denials, your mind might immediately jump to coding errors. But, the fact is that a significant portion of claim denials result from simple data-entry mistakes. During her presentation at Ascend 2016, compliance expert Diane McCutcheon of Business Management Consulting Services gave us the top eight errors behind claim denials:

  1. Data-entry mistakes
  2. Wrong insurance information
  3. Missing claim information (e.g., ICD-10 codes, G-codes, and modifiers)
  4. Missing or invalid referral/authorization
  5. Credentialing or provider issues
  6. Submission outside of timely filing window
  7. Wrong subscriber (a.k.a. beneficiary) information
  8. Failure to submit requested information

When I look at that list, I see policy guidelines that therapy practices could easily implement to prevent each one of those errors. Ensuring proper intake, establishing set timelines, and reviewing documentation prior to claim submission are simple ways to stop denial errors dead in their tracks.

Your staff should have skin in the game, too.

Preventing denials doesn’t fall entirely on the shoulders of the therapist. Well, it shouldn’t anyway. Ensuring cash flow—especially in a private practice setting—is a team effort. Each member of your staff plays a critical role in mitigating claim denials. The key here is remembering to train those employees on a regular basis. And, when changes occur—whether they be procedure or staffing changes—it’s crucial to keep your employees up to speed on how those changes affect your denial management protocol.

A team is only as strong as its weakest link.

As Vince Lombardi once said, “Individual commitment to a group effort is what makes a team work, a company work, a society work, a civilization work.” And your practice is no exception. A team is more than just the sum of its parts, and hiring the right people is crucial to the success of your practice’s denial management policies. If you find you have an employee who frequently fails to catch clerical errors that lead to denials, you may need to decide whether that person is really the right fit for the job. Terminating an employee is one of the less glamorous facets of being in charge, but ensuring you hire the right people will reduce the incidence of these sticky situations—not to mention streamline workflows in your practice.

You need the right tools for the job.

While I can’t stress enough the importance of hiring the right people, even the most stellar employee can fumble every now and then. In the days before EMR software, information was vulnerable to getting lost in translation (or just plain lost, period)—especially when it came to handwritten SOAP notes and claim forms. These days, technology has streamlined the documentation process, and that’s where finding the right billing solution comes in. Billing software—or RCM software—not only reduces the amount of time you and your staff spend filing claims, but also can lower the frequency of denials. That’s especially true if your billing software integrates with your EMR and features built-in checks and alerts. That said, no two RCM systems are exactly alike, so it’s important to consider all of your options as you search for the right software.
Want to learn more about claim denials and how to avoid them? Join denial management expert Diane McCutcheon and me for a free webinar on May 24 at 9:00 PDT. We’ll cover the major roadblocks that prevent rehab therapists from getting reimbursed—and provide strategies for overcoming them so your clinic gets paid every penny it deserves. Not sure you can attend? We have you covered: when you register for the live webcast, you’ll automatically receive our post-webinar follow-up email with a copy of the recording.