A Guide to Claims Denial Management

Denial Management is a key strategy when running a laboratory. Unfortunately, denied claims play a big role in why your laboratory could lose revenue and reduce cash flow. Not only are denied claims becoming more of a problem, but many fail to appeal these claims. On average, 35% of claims aren’t appealed, and this statistic is staggering because simple mistakes are causing your laboratory claims to be denied and are stopping your company from earning more profit. 

Common Reasons for Denied Claims

Simple and avoidable errors are the main reasons your laboratory may experience a higher-than-normal rate of denied claims. One common reason for claims being denied is because of missing information, such as the correct clinical documentation, prior authorization, and demographic information. Other mistakes that could affect your laboratory include having multiple claims, expired filing time limit, and even unconfirmed insurance verification. To avoid these mistakes, it’s crucial to have a team who is knowledgeable and able to prevent a denial from happening in the first place.

Why Aren’t Claims Being Appealed?

The truth behind why your claims aren't being appealed comes down to several influential factors that you could avoid by simply outsourcing your laboratory billing services. The truth is, operating a laboratory comes with an ample number of other responsibilities and the last thing you need to be worrying about is following up on appealed claims. A huge part of the reason claims don't end up appealed is because laboratories don’t have enough resources and time to constantly file and check up on claims. Another prominent reason denied claims aren’t appealed is because it surpassed the window of time to make an appeal, causing lost opportunity and consequently profit loss.

How to Prevent Denied Claims

Accuracy and organization are critical for preventing denied claims. Make sure all documentation contains up to date and precise information. Proofreading all information inputted never hurts and you might even come across mistakes that might cause your claim to be denied. Another component your company can use to prevent claims from being denied is by double checking if a patient has multiple carriers; If so, only submit​​ the carrier encompassing the primary coverage. Last, another tip we recommend is confirming each patient is eligible and verified via their insurance coverage, especially before providing any services.

Acrev Solutions Denial Prevention Strategies

Let us, the experts, deal with managing your claims so your laboratory can focus on other important matters at hand. At Acrev Solutions we have a strong and outstanding Claims Denial Management strategy. Our goal is to avoid a claim from being denied in the first place, but if it is, you can finally feel relieved knowing that at Acrev we will handle the entire process of appeals, so you don’t have to. Trust the numbers, because at Acrev Solutions our Denial Write-Offs have been reduced up to 50%. Reach out today.