One of the more common questions amongst chiropractors is: How do I train my staff how to pursue denied claims properly and increase my collection rate?
Every denied claim is a unique case and needs to be examined individually to determine the appropriate course of action. There simply is not enough time to properly instruct your staff on how to handle each denial properly. In spite of that, there is a general framework that should be taught:
- Determine if the denial is appropriate. The question to ask here is; could this ever get paid? Examples are services that are not covered under the patient’s plan under any circumstance (Medicare/Medicaid patients – therapies rendered by a Chiropractor, etc.). For anything that is not payable you must determine whether or not the patient is liable for the balance, or if a write-off is necessary. If you are writing off services then communication feedback to the provider should be made.
- If the denial is not appropriate, review claim coding for no-brainer mistakes. These mistakes can include an incorrect or missing modifier, not enough regions for spinal adjustment, wrong region for extraspinal, along with others.
- If you are unable to find any obvious mistakes then make a determination for follow-up. If the denial is coverage related you should contact the patient to communicate the denial and obtain updated insurance information from them. For other denials, contact the insurer to obtain further information about the denial and what action is needed to get the service paid.
From there it may be a good idea to review your Collection rate and outstanding revenue in-depth to determine if a greater problem is present. Perhaps you are dealing with poor collections practices for patient liability amounts or excessive “deal” reductions for patients.
If you find that denials are a large reason for a poor collection rate it can be a great help to outsource your billing or use a Chiropractic billing service provider. This will help to decrease the cost of pursuing in house and will assist with billing processes.