Denials in Dermatology Billing and How to Minimize Denials

As a Dermatology Clinic, have you ever dealt with medical billing denials?

No one ever likes to see the word “denied,” regardless of circumstances but when it comes to dermatology services provided in good faith and with patient care top of mind, it can be particularly frustrating. You work hard to support your patients and a denial in medical billing is a loss that any clinic would find hard to absorb. If denials continually occur, it could mean that a re-evaluation of your billing practices is in order. We’ll explore the types of denials in medical billing that you may be experiencing and how we can change “denied” to “Approved” ensuring both your practice and your patients are benefiting!

What does a denial of medical billing mean?

It may appear obvious but the reality is a denial may not necessarily mean a denial. It could be that a denial merely represents the first stage in a process that provides learning opportunities for your practice to improve how billings are submitted, reviewed and appealed. In clearest terms of course, “denied,” does mean that an insurer is refusing to pay your submitted invoice. The formal definition is: “the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for healthcare services obtained from a healthcare professional.” The reality however, and why we speak of an “opportunity” when it comes to denials, is that you may simply have omitted information, not been up to date on billing codes or even had a typo in your submission. These along with a number of other factors may all contribute to a claim being declined. Let’s take a look at some of these reasons now.

Typical types of denials in medical billing:

• Coding errors 

  Probably the number one issue for most denials billing code errors can happen easily when you have busy or new staff, and/or when it’s hard to track constantly changing or new and updated codes.

• Missing Information

  This is another frequently cited reason for medical billing claim denials. Anything missing, from a simple typo to more significant details, will almost always result in an automatic denial.

• Not filed on time 

  Time limits on most medical claims exist and insurance companies are strict! If the limit for filing a claim has expired, you will be denied.

• Services not covered 

  It can be hard to track what is covered and what isn’t, particularly when your patients all have different insurance providers or if you are performing multiple services for one patient. If your staff didn’t have the time to check properly or forgot to check with the patient or provider before procedures were completed, you could be facing a denial.

• Duplicate claims

  This type of error sometimes occurs when services were bundled together for approval by the provider but you’ve submitted them separately. This can lead to possible duplication and a denial of coverage for the entire claim.

Tips for Minimizing Denials:

• Current code expertise

  Ensure that ALL the staff on your team who are responsible for coding are up to date on insurance claim codes and HIPAA compliance too!

• Staff Training

  Ensure your front desk staff are fully trained not just in customer service but in assisting with the claims process by properly registering new patients in your systems, correctly recording insurance coverages, obtaining patient payment and personal information in the event follow up is required and more. This will ensure you have an avenue to potentially collect on denied claims.

• Outsource

  Consider outsourcing your billing services to a reputable and reliable provider who is fully conversant in current dermatology-specific medical billing.