Did You Know the Three Most Common Medical Billing Denials Are Also the Easiest to Avoid?

Managing medical billing denials is a cumbersome, timely, but expected part of the healthcare business for community hospitals. Claim denials that occur less frequently often lay hidden in the complexity of the modern care continuum. The good news is that the most commonly occurring healthcare claim rejections’ origins are easy to spot and can be managed efficiently. 

According to our contract management teams and reports gathered from our hospital customers, some of the most common reasons for medical billing denials are also the simplest to avoid. These denials include: 

1. CO 197 - Precertification/authorization/notification absent 
2. CO 50 - Non-covered services because this is not deemed as medically necessary 
3. CO 22 - Care may be covered by another payer per coordination of benefits. 

Preventing these denials is a matter of creating standardized pre-visit procedures, continuously training-up staff, and curating a consistent awareness of payor requirements. 

In concert with these tactics, hospital business offices constantly facing these common denials should consider outsourcing tools and services that help set their teams up for success well before a patient visit occurs.  

Simple Denials Cause Big Problems  

Managing claim denials is a massive burden for business office personnel and can take its toll on the clinical side.  

For example, if a claim is denied for a medical necessity, that type of casework often takes a good deal of clinical expertise.  

When coordination of benefits is the problem, that usually means reaching out to a patient and gathering the correct coverage information. Working these types of denials usually does not follow the standard appeal process; however, they still drag out the care journey, which is terrible for the patient experience. 

Every denial lengthens the reimbursement process and interrupts operations in various ways. Avoiding these commonly occurring denials often requires a high degree of proactivity and collaboration. Hospitals can help build those characteristics into their entire RCM process by outsourcing some more detailed heavy portions of their business services.  

How MEDHOST Business Office Services Helps Prevent Common Denials 

MEDHOST has various services and solutions to provide checks and further scrutiny to previsit processes and claim submissions to catch potential problems. Some of these services add automation to billing and registration processes, which can also help improve the accuracy of hospital staff. While other services cover the entire resubmission process, taking much of that burden off the hospital’s business office.  MEDHOST also builds intake forms with required fields, alerts, and notifications that act as reminders for essential steps. 

In addition to helpful integrated solutions that help ensure proper and accurate documentation, our Business Services team works with hospitals to create customized solutions tailored to their needs. These services are helpful in every stage of the revenue cycle management process. 

To find out how MEDHOST can help your team avoid these common medical billing denials and accelerate the payment cycle, reach out to us at inquiries@medhost.com or call 1.800.383.6278.