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10 Tips for Preventing Denials in Your Health Center’s Revenue Cycle


Denials are far too common when you’re submitting claims to insurance companies. After all, insurance companies don’t particularly like paying out money. If your health center struggles with denied claims, follow these 10 tips to improve your success rate.

1. Verify Your Patients’ Insurance

Denials based on eligibility are more common than you might think. Best practices include verifying your patient’s insurance and eligibility with every visit. They may forget to tell you that they changed jobs and insurance.

2. Use Accurate Information

When you submit a claim, you must provide up-to-date and accurate patient information. This includes their full name, date of birth, policy and group number, and the patient’s relationship to the insured. Incomplete or inaccurate information can lead to unnecessary denials.

3. Prior Authorizations

According to insurance companies, not all services rendered are deemed to be medically necessary. For this reason, your federally qualified health center may need to obtain prior authorization or a referral for certain services to ensure your claim gets paid.

4. Select the Right Medical Code

Entering the wrong billing code can translate to a denial of your claim. Therefore, when submitting codes, be as specific as possible. If possible, include the code up to the fifth digit.

5. Stay on Top of Billing Changes

Periodically, billing codes may change. The most recent change affected telehealth visits, which have surged in numbers since the start of the COVID-19 pandemic. Using the correct codes for telehealth visits and following the most current versions ensures that your claims are paid in a timely manner.

6. Understand Your Payers and Follow Their Rules

By gaining a thorough understanding of what your primary payers require, you can minimize denials and even expedite the payment process. Become familiar with their website, their system, and the procedures they cover. Better yet, develop a rapport with the provider and know where to go for answers. Asking questions is preferable to submitting a claim that ends in denial.

7. Watch for Deadlines

Deadlines for filing claims can vary for different providers. Therefore, it’s important to check with each claim to avoid sending a claim too late. Even editing an existing claim can mean you missed a deadline, and with it, the revenue for the procedure.

8. Automate as Much as Possible

Technology can help you prevent many of these problems by flagging incomplete or inaccurate claims for you. With the right revenue management system in place, you won’t accidentally file a claim that’s missing patient information or the proper authorizations.

9. Track Your Success

The best way to learn from past mistakes is to analyze them. Take the time to go through denials and learn the reasons behind them. Work with your staff to get everyone trained to improve your company’s bottom line.

10. Communicate with Your Team

For accurate billing, the doctors and staff must communicate properly. If the billing code doesn’t match the service the doctor provided, it may cost your health center lost revenues. Federally qualified health center revenue cycle management requires commitment from your entire team, and doctors and clerical staff need to work together to streamline the billing process and prevent miscommunication and billing mistakes.

Avoid Denials in Your Federally Qualified Health Center

It’s important to make sure your health center is paid appropriately for every procedure, so follow these 10 tips, and hopefully, you’ll start to see fewer denials.

If all else fails, call a Synergy Billing Specialist! We are here to serve you, 877.242.8475.

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