How To Avoid Claim Denials: Top 4 Tips and Tricks

One of the biggest frustrations when submitting acupuncture insurance claims to insurance companies is dealing with denials. Denials cause a huge burden on staff and can have a devastating effect on your practice’s revenue.

From all our years in the holistic billing industry, we have narrowed down the most common claim denials to the top 4.

1. Timely filing- all insurance companies have a window of allowed time to submit your claims. This can vary from one payor to the next and is also practice specific. Whether you are in or out of network with the insurance company will also play a big factor. If the provider is submitting claims and also treating the patients, one can see how this may be a factor. If the front desk also has their hands full, they may already be spread too thin and miss important deadlines.

2. Incorrect or missing modifiers- claim submission is so much more than just a data entry job. Often times the biller and or coder must look at the bigger picture of the claim and append the appropriate modifiers to a claim. If more than one procedure is done on the same day, chances are a modifier is needed.

3. Coding specificity- in the world of ICD-10 coding, coding to the highest specification is extremely important. In fact, ICD-10 was created for this reason alone. ALWAYS code to the highest degree of specificity. Using general diagnosis codes such as "leg pain" instead of "left leg pain" is a sure way to get a denial.

4. No benefits- one of the most important roles of the billing cycle is verifying patient benefits. If a patients plan was not verified accurately, you may be setting yourself up for another denial and leaving the patient with bigger out of pocket cost than expected.

In order to keep your income flowing and your practice flourishing you and your staff should strive for a 95% clean claim rate. This means more than 95% of claims submitted should be processed and paid correctly within the first attempt.

If you or your staff is not meeting this number, it may be time to give us a call!