Insurance claim denials are a common challenge in the industry, and handling them effectively is crucial for maintaining smooth operations and ensuring timely payments. Money Tree Billing has found a structured system that makes addressing claim denials streamlined and effective. Curious? Here’s the journey a claim goes through to ensure proper processing.
Step 1: Your Software – Pre-Billing
Most billing software programs include a claims error report. Prior to billing the claims, your software error report will indicate if any of the accounts you are trying to bill are missing information required by the program. These reports are generally easy to read and help to catch data entry errors prior to billing and missing claim information.
Step 2: The Clearinghouse – The First Line of Defense
The clearinghouse is often where a large portion of denials occur. This is the first checkpoint, after billing, where claims are scrubbed for errors before being forwarded to the insurance carrier. Denials at this stage are common and can arise from a variety of issues, such as incorrect information, coding errors, or missing documentation.
How We Manage Clearinghouse Denials:
- Rotating Monitoring Process: We’ve established a system that regularly rotates through the clearinghouse reports, keeping an eye out for any denied or rejected claims to address them as soon as possible.
- Real-Time Follow-Up: Denials are addressed as soon as they appear. Whether the claim was rejected due to a minor error or a more complex issue, we follow up quickly to prevent delays.
- Proactive Prevention: At MTB, we have specialized departments that allow our staff to be trained to avoid common mistakes that lead to denials, such as incorrect patient information or improper coding, reducing the chances of claims being flagged in the first place.
Monitoring claims through the clearinghouse process allows us to expedite the acceptance process. Resolving issues early prevents the same issues from showing up repeatedly.
Step 3: Explanation of Benefits (EOB/ERA) – Handling Post-Clearinghouse Denials
Once claims pass through the clearinghouse, they are sent to the insurance carrier for processing. When they return to us from there on an EOB, we go through and address the denials. Denials that occur on this step tend to be more specific and may require more attention. These are our strategies.
How Money Tree Billing Manages EOB/ERA Denials:
- Quick Fixes: Simple denials, such as those related to minor discrepancies or missing information, are corrected right away during the posting phase. Our experienced team is trained to recognize these quick-fix denials and address them promptly.
- Flagging Complex Denials: For more complicated issues—such as eligibility disputes, coordination of benefits, or medical necessity denials—we flag the claim for later review and set it aside. These claims are prioritized based on urgency and impact with set, regular check-ins and circlebacks to ensure resolution.
By managing denials efficiently at the EOB/ERA stage, we can prevent bottlenecks and ensure that claims continue to move forward without unnecessary delays.
Step 4: Aging Report – The Final Line of Defense
The aging report serves as the last safety net for claims that have slipped through the previous stages. A majority of claims are caught at the clearinghouse or EOB level, the aging report is designed to catch anything that might have been missed.
Details of Aging Report Denials:
- Thorough Review: Claims that appear on the aging report should be carefully reviewed for any errors or issues that weren’t caught earlier. Claims that slipped through the cracks previously are scrutinized closely.
- Resolve the Root Cause: Identifying why the claim was missed in the previous stages, we make any necessary adjustments to the process to prevent future occurrences.
- Reporting and Accountability: Keeping track of how often claims end up in the aging report is one of the final steps. If certain types of denials keep reappearing at this stage, it may signal a larger issue in the claim submission process that needs to be addressed.
The aging report acts as a final safeguard, ensuring that even if a claim gets denied or overlooked in earlier steps, it can still be resolved before causing any financial impact.
Handling insurance claim denials is a daunting task, but with a structured approach, it runs smoothly here at Money Tree Billing. By addressing denials at each stage—clearinghouse, EOB/ERA, and aging report—we can significantly reduce the time and effort required to resolve them. Implementing best practices, keeping a close eye on trends, and investing in the right tools ensure that your claims are processed smoothly and payments are received without unnecessary delays.
Money Tree Billing is a chiropractic billing company that removes the distraction of billing from your office so you can focus on changing lives through chiropractic care. Money Tree Billing offers complete billing cycle management through a dedicated and seamless billing process. We empower you and your team with support beyond just billing. Focus on your practice and your passion and we’ll focus on getting you paid. We GUARANTEE our work. Money Tree Billing guarantees if your insurance claim goes unpaid due to our error, that we will credit you the amount you would have been paid on that claim. You won’t find another guarantee like it in the industry. To learn more about Money Tree Billing, and our one-of-a-kind guarantee, visit www.moneytreebilling.com.
