Medical Billing Plagued by Denials Based on Registration Errors

Lea Chatham July 8th, 2013

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By far, the most frequent type of denials in medical billing are those that are related to registration. These denials center on the patient’s eligibility for insurance coverage – or, in the case of a denied claim, the lack thereof. If the patient isn’t eligible for the services you render, you can (and perhaps should) bill the patient. That sounds like a great solution until you realize that you aren’t likely to be paid – industry experts reveal that 81 percent of self-pay patient responsibility and 55 percent of all patient financial responsibility end up as bad debt.[1] Thus, before you transfer the invoice to the patient, check all other sources of registration information you can access, such as the hospital’s registration system, and verify every character on the card that you captured at the point of service.

Since some, if not most, registration denials end up as patient bad debt, it pays to make pre-visit eligibility verification an integral part of the registration process. Download your schedule of all patients with upcoming appointments into an automated eligibility system or perform real-time eligibility, available through most practice management systems. If you don’t have access to an automated eligibility process, sort your appointment schedule by payer, and perform individual eligibility checks using each payer’s website. That takes some staff time but the denials you will avoid make it more than worth the effort.

Performing eligibility verification a day or two prior to the patient’s appointment allows time to contact ineligible patients about an alternate insurance. For those patients who no longer carry insurance, you can communicate with them and state your expectations about payment arrangements. At minimum, you can make the request for alternate coverage as the patient checks in for his or her appointment.

If you want to hear more about why claims are denied and learn proven strategies to effectively address denial management, join me on July 17 for the free webinar Denial Management: Tested Techniques that Get Claims Paid.

About the Author

Expert ElizabethWoodcock will explain best practices for appealing denied claimsElizabeth Woodcock, MBA, FACMPE, CPC is a professional speaker, trainer and author specializing in medical billing and practice management. She has focused on medical practice operations and revenue cycle management for more than 20 years. 


[1]McKinsey & Co:  Overhauling the US health care payment system, June 2007; The Advisory Board Company, Financial Leadership Council. 2007. Cultivating the Self-Pay Discipline.

 

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