Top 3 Billing Denials and How to Prevent Them

By May 1, 2019
hand on calculator

By Jacque Woolsey, Business Analyst at Remarkable Health

One of our goals at Remarkable Health – something we are constantly striving towards – is to create solutions to make people’s lives 10X better. In this effort and for the purpose of this blog, we want to focus on you, Billers! We want to focus on how to make your life 10x better. And what better way to help than to reduce the top denials on claims? Here are three of the top denials and the ways CT|One can be utilized to reduce the denials on these claims.

  1. Authorization is Required. I have never seen someone jump with joy when this is the denial on a claim. Simply put, this is the start of a potentially long process of researching if the service was pre-authorized, if the data was just not in the system, if the payer will backdate an authorization for this service, the list goes on. Are you ready for great news? CT|One has options to help prevent these denials:
    • If a payer requires an authorization on all services provided to a client, the system can be configured for the one payer to require an authorization on all claims, prior to submitting the claim to the payer.
    • If a payer requires an authorization only on specific services, the procedure code can be configured for the one payer to require an authorization on claims with that specific procedure code, prior to submitting the claim to the payer.
  2. Duplicate Service/Claim. Each payer and contract can be just slightly different then the next, especially when it comes to providing multiple services to a client on the same day. Some payers require these services to be combined and submitted under one claim, while others require these services be submitted on separate claims. The possibilities are, unfortunately, endless. Here are a few ways CT|One can help with same day services:
    • If the Dates of Service, Procedure Code (including Modifiers one (1) thru four (4)), Place of Service, and Facility are identical on the individual services, these can combine into one (1) claim.
    • If the payer limits the number of units that can be submitted in one day for a service, CT|One can be configured to limit the total number of units on a claim, based on the payers maximum allowed amount.
  3. Timely Filing. Every role within an agency has important timelines and goals to meet. It is an understatement (to say the least) that Billers have innumerous moving pieces to monitor, update and balance. There is a process in CT|One to help eliminate steps in the billing process by creating the Claims and/or Claim 837 file on an automated schedule. This process is completely customizable to determine when the process runs for a specific payer/clearing house, which staff gets notified of the records processed, and additional work needed to move to the next step.

Reducing denials on claims – especially in areas of frequent occurrence – is a way we want to make YOUR life 10X easier. If you are a Biller currently utilizing CT|One and would like additional training on how to utilize the above tools to prevent denials – please contact our team!

To learn how Remarkable Health can help your team reduce billing denials, schedule a 30 minute meeting with one of our specialists today.