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Using Errors to Measure Performance and Prevent Future Denials

When your business is physical therapy and healthcare, much of it involves insurance loopholes and paperwork. If the sheer volume of rules and regulations weren’t bad enough, the complicated processes you need to adhere to can cause you or your employees to make mistakes. And when you make mistakes in insurance billing, your practice’s revenue suffers… and you tear your hair out.

But keep in mind that the only bad mistake is the one you don’t learn from.

Analyzing the errors you make can help you prevent insurance claim denials in the future. Furthermore, you’ll better understand your employees’ performance on the job.

If you don’t analyze errors, they’ll keep happening again.

Independently Monitor Denials 

No doubt you utilize some sophisticated – and expensive – software for your claims and billing. You may even have several dedicated employees in separate departments. Regardless of all of that, if you want to learn from your mistakes and prevent insurance claim denials, you should independently monitor and analyze each denied claim. In other words, have someone else go over the data at arm’s length. Utilize the software, create a spreadsheet and list the denial reasons, who wrote the claims, the sources, and other relevant details. Use this information to determine the percentage of denials to your revenue stream. You will also see where your weaknesses (and strengths) are.

Of course, if this seems too much, have a third-party billing and collection service come to your aid.

Sometimes, It’s You…

Are you asking too much? Your employees are but a cog in the wheel that is your practice. They follow your lead and the materials you give them. If denials occur, it may be the fault of admin or management or a breakdown in knowledge. But check to see if you have done enough to support them. Getting to the bottom of these issues can definitely help prevent insurance claim denials. Systematically look at the factors that caused those denials. What processes have you laid out that aren’t working?

Analyze everything and you may see that an outside company may be better equipped to handle this side of your business. It’s not a failing on your part if that’s what you decide, but strong management.

Overworked and Understaffed

To prevent insurance claim denials, you need to have a grasp on how your staff is performing. Depending on the client load of your business, you may not have enough staff to handle all the paperwork. Each client can have his/her own insurance company, and all those companies have their own rules and some even have specialized coding outside of the normal realm you’re used to. Don’t let your people be underwater, otherwise claim denials are soon to follow and crucial revenue flow will diminish. Use their level of mistakes to gauge how well you are staffing and training, then reevaluate.

It may be time to give the billing over to a specialized PT billing and collections company, or else hire more specialized staff to better affect the outcome of your claims. What route you take is determined by how your bottom line fares. Either way, you’re learning from your mistakes.

Creative Commons Attribution: Permission is granted to repost this article in its entirety with credit to Jet PT Billing and a clickable link back to this page.

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