5 Common Causes of Claim Denials and Delays

It’s now the middle of the year. How are your revenue cycles doing so far?

If you’re shrugging your shoulders or letting out a loaded sigh, chances are your revenue cycles aren’t flowing as smoothly as they should be, and we know the biggest reason why: claim denials and delays.

As much as you’d like to keep your cash moving, there always seems to be a snag when it comes to claims. For some unfortunate physical therapists, waiting for reimbursements can even take up to five months! That’s more of a sinkhole than a cycle, and you need to get out of there fast.

The first step to getting out of that revenue rut is to recognize the biggest causes of claim denials and delays. Only by knowing and understanding these causes can you avoid them and consequently make sure that your revenue cycles keep turning in the right pace.

Here are the most common causes of claim denials and delays:

1. Incomplete or wrong information.

The root of claim denials can come right from the start, during registration. When intake staffers don’t verify patient insurance and other vital information, they end up sending incomplete or erroneously filled-up claim forms which of course, end up denied. Make sure that your staff are well-trained in this area. They need to make sure that all information are filled up completely and correctly. You can provide them with a list of the most commonly missed fields, such as the specific dates, patient subscriber number, etc. You could also double-check claims before they are sent out, or have a reliable billing company double-check these for you. This process may be a bit more time-consuming, but it is so much better than having to endure another denied claim.

2. Incorrect codes.

Codes need to be specific to the highest level, as even the slightest ambiguity can lead to a denial. Make sure your billers and coders are up to speed when it comes to coding to avoid sending incorrect or incomplete codes.

3. Late submission of claims.

Of course, no matter how complete and correct the code and information, if the claim is submitted past the deadline then of course it will be denied. This can be quite frustrating. To avoid this, you need to take note of each payer’s deadline. It would help to have all these deadlines posted up where all your billing staff can see them.

4. Lack of coordination among staff.

The number of steps and staff involved in the revenue cycle can lead to staff members miscommunicating, assuming requirements have been fulfilled and other such process potholes that in turn, lead to delayed claims. If such is the case with your staff, it’s best to regroup and redefine each person’s role in the revenue cycle and make sure that everyone is proactive in the goal of achieving a smoother, faster revenue cycle.

5. Failing to comply with individual third-party payer requirements.

Several third-party payers and private insurance carriers have specific processing procedures that need to be followed otherwise, there will be a delay in reimbursement. Make sure you’re well aware of these particulars and follow them diligently to avoid unnecessary back and forth as well as correcting of errors and their resulting delays.

Should avoiding these causes prove too labor-intensive for your practice or if you want a simpler, proven way of managing revenue cycles, you can always turn to Park Medical Billing.

Park Medical Billing is a certified medical billing company with services and technology that have been proven effective in managing revenue cycles and maximizing revenue for physical therapy practices. Learn more about what we can do for your practice. Give us a call today on 1-201-585-7306.