Physician practice strategies to prevent insurance denials

Insurance benefits
There are steps practices can take to help prevent payer denials.

Payer denials are a frustration for physician practices, but there are steps to take to address the problem.

A 5% denial rate is average and practices should be concerned if their rate is above that level, consultant Elizabeth W. Woodcock told Medical Economics. And now is an important time to pay attention to denials. The ICD-10 grace period for physicians, which applies to code specificity, ended last October. Joseph W. Stubbs, M.D., an internist at Albany Internal Medicine in Albany, Georgia, says he has already seen denials due to unspecified codes since the grace period ended.

So what can practices do about payer denials? Here are just a few of the experts' suggestions:

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

Validate patient information every time the patient comes to the office and be sure the specific insurance plan is covered under your contract with a payer. Dig to find out the reason for the denials and make sure to correct inaccurate patient information to prevent the same denial issue, Maureen Clancy, senior vice president of revenue cycle management and credentialing at Privia Health, told Medical Economics.

Educate physicians about the top denials that occur in the practice on a weekly basis, Woodcock recommends.

Know what information insurers need to process claims and provide it consistently, according to Patricia Cortez, practice administrator at Plano Internal Medicine Associates in Texas. Know what your contracts allow. For instance, will a payer reimburse you for labs done in-house or does it require you to send lab work outside?

Know what medications you can prescribe. Physicians should check an insurer’s formulary before prescribing medications and prescribe generics whenever possible, according to Yul Ejnes, M.D., an internist with Coastal Medical in Cranston, Rhode Island.

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