Physician practice strategies to prevent insurance 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:

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.