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How to avoid Medical Claim denials: Top 8 ways to recover revenue.

How to avoid Medical Claim denials: Top 8 ways to recover revenue.

If your healthcare facility comes across denial claims, you must be aware of how this can be fairly frustrating. It means you would need to put more hours into resolving the claims, while your revenue suffers simultaneously. 

American Medical Association states that medical providers spend almost USD 15,000 to investigate, make phone calls, and on necessary tasks needed for reworking claims. Medical billing can become a challenging process, however, there are ways to improve your reimbursement rates by lessening claim denials.

Let’s look at some ways you can manage your denied claims. 

You can automate your system

Maintaining track of all the diagnostic codes and various insurance policies can become exhausting, however, there is countless software available that will assist you in this task. They can automatically update required codes and make your tasks easier for you. This will make things easier for your billing team as they could utilize their time to double-check claims. 

Another advantage to having automatic software is that it will detect errors in the documentation before the submission of claims. This enables your team to prepare to get reimbursed. 

Aware of changes

Even if your software does its job efficiently, your team needs to remain on top of the policies and practices of Medicare and other medical aids. Your billing can do this by subscribing to newsletters and keeping track of upcoming conferences. This will prevent any claim denials due to negligence or ignorance. Motivating your team to maintain knowledge of payors is going to help your practice and the revenue you generate. 

Prioritize Up-front

Most denials come because of minor errors or details. Training your front office staff to deal with these details instantly could help this process. It would also ease the back-end team to focus on time-consuming tasks. 

Improve management

You must set strict policies to ensure that denials are minimized and reimbursements are maximized. By setting up procedures and policies, your team will make sure to check reimbursement requests before they are sent out. This will assist your practice to track all claim denials and improve the performance of the department. Maintaining the management of your facility will take you a long way in minimizing claim denials. 

Investigate causes

It may require some effort on your end, but following up on a claim denial will be worth it. Millions of dollars are not reimbursed properly each year because the billing department lacks investigative efforts. 

Work on Denials everyday

Medical facilities are focused on catering to daily claims that they often fail to address denial claims. If your facility makes it a routine standard task to work on denial claims daily, it would improve your revenue significantly. If a claim has been denied once, that does not necessarily mean it will be denied again. After proper revision, investigation, and re-working, you will get reimbursed. 


With medical procedures and services, you are dealing with a variety of codes and numbers which increases the chance of errors. Your staff needs to be vigilant and check for errors before they finalize a claim. There cannot be enough emphasis on re-checking your claims. The extra effort invested in this process would prevent denial claims. 

An eye out for deadlines

Medical billing is a complex area that makes denial claims to become inevitable. If there is one mistake too grave to make is failing to submit your claim in time. If you miss your deadline, there is no way to fix this. Hence, your capital is lost and cannot be recovered. With effective training of your team and encouraging them to maintain deadlines, you can easily avoid a missed deadline. Ideally, you should maintain a 0% rate of denial based on late filing. 


In every medical practice, maximizing your reimbursements means you are increasing your revenue to the maximum. Without an expert and trained billing department in place, it’s difficult to lessen denial claims for any and every reason. A well-managed and professional team will ease your burden and make your practice stress-free. 

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