Most home healthcare providers lose a substantial amount of revenue because of insurance claims denials. Home healthcare providers often find it challenging to handle denied claims in their home healthcare billing process. In an ideal home healthcare billing structure, out of 100 claims, not more than 10 claims should be denied. The reality is that most home healthcare providers encounter denial rates as high as 30 percent or even more.

The in-house home healthcare billing team often struggles to handle both the new claims and denied claims within a tight deadline. Fortunately, your in-house home healthcare billing team can reduce denied claims drastically by leveraging the following effective denial management strategies-

Effective denial management strategies for your home healthcare billing:

1) Collect accurate patient information:

Inaccurate or incomplete patient information is a primary cause of claim denials. Home healthcare providers should prioritize collecting and verifying precise patient details, including demographics, insurance coverage, and contact information. Implementing comprehensive patient registration procedures and utilizing electronic health record (EHR) systems can minimize errors and ensure data accuracy.

2) Insurance Verification:

Before providing care, confirm that the patient’s insurance policy is active and covers the necessary services. This process clarifies whether the patient or their insurer is responsible for payment. Carefully review the patient’s insurance policy to understand the coverage benefits and exclusions. If the patient has a high deductible plan, inform them of their financial responsibilities before providing home healthcare services.

3) Receive timely prior authorization:

When it comes to reducing claim denials and receiving timely reimbursements for your home healthcare, prior authorization plays a vital role. Your internal PA team should know how to obtain PA fast and measures to avoid any errors. The team should carefully check if any therapy, medication, and DME is covered by a patient’s insurance company.

4) Stay on top of the latest coding guidelines:

Home healthcare coding and billing rules are constantly evolving, so staying up to date is crucial. Conduct regular training sessions for coding and billing staff to ensure compliance with current standards, thereby minimizing the risk of claim denials due to coding errors.

5) Perform regular claims audit:

You should conduct regular claims auditing to spot any errors and correct that before submitting claims. You should streamline a claim scrubbing process to find errors, missing information, or inconsistencies in claims. By correcting the issues diligently, you can avoid the risk of claim denials.

Outsource denial management:

Outsourcing denial management to a specialized home healthcare billing company enables you to address denial issues efficiently, reduce operational costs, and concentrate on core activities. To ensure success, clearly define your goals, select the right partner, and maintain regular communication with the billing company.

If you need a reliable billing partner for your home healthcare, consider Sunknowledge. With over a decade of experience, Sunknowledge has successfully supported many home healthcare providers with advanced billing, quick prior authorization, effective coding strategies and efficient denial management plan. For a strategic approach to your billing needs, contact the experts at Sunknowledge today.


Leave a Reply

Your email address will not be published. Required fields are marked *