Your holistic practice’s health insurance denial rates are some of the most significant indicators of your medical billing success. Unfortunately, they’re also one of the most difficult elements of your billing operation to improve. If you’re not paying close attention to your insurance claim denials rate, you’re jeopardizing the financial stability of your practice. By following these best practices guidelines, you can avoid insurance claim denials and achieve your holistic practice’s overall revenue potential.
What Are Insurance Claim Denials?
The medical billing process is integral for practices to receive reimbursements from health insurance companies. When patients utilize insurance to pay for treatments, healthcare providers have to submit claims so they can be paid for their specific services from the insurance companies. While medical billing ensures that holistic practices receive their due payments for treatments, it’s also a complex process. 
If claims are missing information or filled out inaccurately, then they can be denied by the insurance companies and stymie the reimbursement process. Insurance claim denials are frustrating to any holistic practice; not only is the payment completely denied or delayed, but the time it takes for reimbursements can extend to weeks or longer. For the most timely and full reimbursements, holistic practices must keep denials in medical billing as minimal as possible.
Common Reasons for Claim Denials
The five most common procedures denied for holistic practices are:
- Manual therapy
- Heat/cold therapy
- Office/outpatient established visits
- Injections
- Acupuncture services.
For strong revenue cycle management, holistic practices should aim for a 95% clean claims rate; maintaining a high clean claims rate increases your practice’s efficiency and overall profitability. So, how can your practice avoid insurance claim denials and maintain a strong clean claims rate? Here are some of the top reasons for denials in medical billing:
Lack of Coding Specificity
Especially in the ICD-10-only landscape, claims that aren’t coded to the fullest level of specificity possible are ripe for denial by both public and private payers. That means that all identifiers and modifiers must be included on every claim, every time, covering concerns as granular as possible.
Billing Duplicate Claims
Even in well-organized operations, it’s surprisingly easy for practices to submit claims relating to the same encounter more than once. It may happen when a team member resubmits a claim before hearing back from the insurance company on the initial submission or fails to check on existing documentation as to whether the claim was submitted from the start. Either way, it’s an easy ticket to an unnecessary denial.
Timely Filing
Organizations often see unnecessary denials for failing to submit claims within the payer’s filing window. Why do practices wait? While reasons vary, the issue usually comes down to bandwidth and time: If your staff is stretched too thin, it’s impossible to address all of your front-office and back-office responsibilities in a timely manner. Contracting with a medical billing company is a smart way to keep filing deadlines from slipping past you.
Unverified Insurance
Insurance claim denials can be the byproduct of established patients updating their insurance without letting your practice know. Staff members may assume that regular patients have not had any changes to their insurance. However, if there have been changes to their insurance and no one checks their eligibility, then you might be headed straight for denials. Verifying your patient’s insurance at every visit can ensure there are no insurance-related issues during the billing process.
Best Practices for Avoiding Insurance Claim Denials
After learning the common reasons for insurance claim denial, try the following denial management tactics!
Track Every Claim
No claims should ever get “lost” in your practice management system. If that’s happening to you, it’s imperative to implement a more comprehensive process for tracking where claims stand throughout the entire revenue cycle. In many cases, claims slip through the cracks because they’re not handled fast enough by the team at your practice. Make sure your coders are coding every encounter on the same day as the date of service, then upgrade your technology to a system that scrubs, submits, and monitors claims with minimal employee effort.
Identify the “Why” In Your Insurance Claim Denials
Simply put, you can’t lower your denial rate if you lack an understanding of why your claims are being denied! Review all of your denial notices from a set period – for example, three or six months – and log the associated reasons for the denial. Look for patterns, then talk it out with pertinent staff members to get back on track.
Follow Up In Time
Most denials can be corrected and resubmitted within a given time frame, which varies from payer to payer. Find out what the window is for each of your major players, and make sure it never slips past you. Better yet, create a window of your own, like five to ten days, during which it is your billing team’s top priority to follow up on every denial and correct or appeal when appropriate.
Automate Eligibility Checking
Unfortunately, many holistic practices handle eligibility checks in an unstructured, unsophisticated way – heavy on last-minute calls to payers in advance of a patient appointment, or sometimes even after services have been rendered. Neglecting eligibility checks – or managing them in an outdated way – is a disservice to your patients and practice!
Reduce Your Claim Denial Rate with Holistic Billing Services!
By using these tips to reduce your holistic practice’s claim denial rate, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!
Did you know the healthcare industry loses more than $150 billion a year to no-shows alone? While there are a variety of reasons patients might miss their appointments, like simple forgetfulness or something unexpected taking precedence, it’s in your holistic practice’s best interest to implement a no-show policy. Without one in place, you’re leaving money on the table and wasting your staff’s precious time.
What is a No-Show Policy?
A no-show is when a patient misses their scheduled appointment without informing your holistic practice; this is different from a cancellation, which accounts for the patient communicating their intentions with your practice.
Thus, a no-show policy is the set of guidelines, rules, and penalties that a practice implements to manage patients who intentionally – or unintentionally – miss their appointments. Such a policy discourages your patients from missing their appointments and therefore reduces the adverse impact of no-shows on your holistic practice.
The Effects of No-Show Appointments on Holistic Medical Practices
Simply put, appointment cancellations and no-shows bring only negative consequences to your holistic practice. A missed appointment means no revenue and leaves your knowledgeable staff idle – all cost and no compensation. Precious resources like time and money are wasted when a patient cancels last-minute or doesn’t stick to their appointment, which significantly impacts your practice’s bottom line.
Strategies that aim to overcompensate for no-shows, like overbooking appointments, mean that your holistic practice can’t efficiently allocate its resources; essentially, such approaches can be fiscally irresponsible and result in the burnout of your staff.
What Are The Benefits of Creating a No-Show Policy?
Streamlines the Appointment Cancellation Process
Implementing a no-show policy helps your staff know what to do when patients don’t show up for their appointments. With an established protocol to refer to and communicate with patients, your employees can limit scheduling disruptions, handle follow-ups and rescheduling efficiently, and even fill empty time slots more quickly so your holistic practice won’t miss out on the income potential for that particular time window. 
Discourages Patient No-Shows
Since a no-show policy informs patients of the fees they will incur if they don’t show up, it discourages them from missing their appointments. Without a no-show policy, patients have no accountability whatsoever that will encourage them to go to your clinic.
Boosts Revenue Cycle Management
Ideally, every appointment you set should bring you money. If your patients don’t show up for their appointments, you don’t get paid. The fewer no-shows your practice has, the fewer disruptions there are to your workflows! This means your holistic practice’s patient and team scheduling staff run smoothly since they won’t have to spend extra time overbooking each day in the event of no-show patients. All of this ultimately means you’ll be more profitable since your operations will be better streamlined to account for forgetful patients.
How to Write a No-Show Fee Policy
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Enable your patients to cancel in a convenient manner
Allow a timeframe for patients to cancel or move their appointments without getting penalized. Life happens, and it helps your patients to have the ability to cancel or reschedule their appointments on their time. When you add an appointment cancellation window in your no-show policy, you show your practice to be understanding and caring. That’s good for business, of course. You don’t want to be viewed as a holistic practice that nickels and dimes its patients!
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Establish fees for canceling – or to incentivize keeping the appointment
Fees in a no-show policy will help deter patients from missing their appointments since they’ll know how much it’ll cost them; you can also utilize a type of reward system to incentivize patients who keep their appointments! Consider these points when writing your policy:
- Straight fee: Every time patients miss their appointments, they’re charged a no-show fee
- Reward system: Patients who show up on time and keep their appointments can get rewards, such as gift cards or other incentives, depending on your practice.
- Fee erased upon return: A small fee is added to your patients’ bills when they don’t show up for their appointments; however, if patients reschedule and arrive on time, the fee is removed.
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Explain how your policies are enforced
Besides charging a fee, implement best practices that prevent patients from rescheduling if they exceed a specific number of missed appointments. For example, if you set a no-show limit of three appointments and your patient fails to show up for the fourth time, restrict their online or over-the-phone booking privileges. Be sure to send patient no-show letters to remind repeat offenders of the importance of keeping their appointments, and follow up on patients if they need to reschedule. Doing so discourages patients from missing their appointments without canceling, can minimize no-shows, and can reduce potential costly disruptions to your holistic practice’s workflows.
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Remind your patients of their appointments
Part of your policy should be outlining a timeline of when the patient will get reminders about their appointments. Patients can sometimes forget their appointments, hence the no-shows. Prevent a good chunk of no-shows by calling patients a few days before their schedule or sending them quick reminders. In your policy, list when these notifications might happen so they can expect to get them.
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Communicate your policies
Any new policy is only useful if the pertinent parties are aware of it! Ensure your patients know the consequences of missing appointments by communicating your no-call no-show policy. Below are a few common, yet effective, strategies to inform your patients about your policy. 
- Display your no-show policy on your online booking portal so patients know the guidelines and associated fees if they miss their appointments without giving you notice.
- When patients set appointments over the phone, ensure your employees inform them about your no-show policy. Your staff can say something like, “We look forward to seeing you. If you need to cancel your appointment, please do so within the next 24 hours to avoid getting charged the no-show fee of $25.”
- Include your no-show policy on your website so your patients can access it easily. To get more bookings, add a link to your appointment form or include your phone number so your patients can set appointments immediately.
Without a solution in place to reschedule no-shows, improve cancellation management, and fill empty appointment slots, these tasks are wasting your staff’s valuable time. That’s time that could be spent providing a top-notch care experience, making each and every patient feel welcome, or helping patients coordinate care, or answering patient’s non-clinical questions.
Since 1999, Holistic Billing Services has handled coding and billing issues for a variety of healthcare practices. We understand that each practice is unique and requires a customized solution that aligns with its long-term goals and increases its medical billing metrics. That’s why we work closely with our clients to help them set up holistic billing services and solutions that meet their specific needs and allows them to deliver the best care possible. To find out what we can do for your practice, contact our team today for a consultation.