5 Ways Physician Billing Services Reduce Claim Denials and Increase Revenue

For healthcare providers, managing revenue flow efficiently and minimizing claim denials are crucial to sustaining and growing their practice. Claim denials not only delay payment but can also lead to potential revenue loss if not managed properly. That’s where Everest A/R Management Group steps in, offering a range of strategies designed to reduce denials, streamline the claims process, and boost revenue. Here, we’ll explore five effective methods Everest uses to help healthcare providers experience fewer denials and improved collections.

1. Comprehensive Pre-Authorization and Eligibility Verification

One of the primary reasons claims get denied is due to errors in patient eligibility and authorization.  Everest A/R Management Group has a rigorous process for verifying patient insurance eligibility and obtaining the necessary authorizations before services are rendered. This proactive approach ensures that all patient information is correct from the start, reducing the likelihood of denials due to eligibility issues.

Example: Practices that implemented Everest’s pre-authorization processes saw a significant reduction in denials related to eligibility issues, with some practices reporting a 30% decrease in such denials within the first three months.

2. Thorough and Accurate Coding Practices

Accurate coding is the backbone of medical billing. Mistakes in coding can result in immediate claim denials or delayed payments.  Everest A/R Management Group employs certified coders with expertise in the latest coding standards (ICD-10, CPT, HCPCS). They meticulously review claims for accuracy and compliance before submission, ensuring all necessary codes are included and accurately represent the services provided.

Example: By refining coding accuracy, Everest helped a midsize family practice reduce coding-related denials by 25% in just six months. As a result, the practice not only improved its revenue stream but also reduced time spent on claim resubmissions.

3. Streamlined Denial Management and Appeals Process

Even with preventive measures, some claims may still face denials. For such instances,  Everest A/R Management Group has a dedicated denial management team that reviews each denial closely. This team identifies the root cause and quickly initiates an appeal process with the payer. By handling denials efficiently, Everest maximizes the chances of claim recovery and reduces revenue loss.

Example: A multi-specialty practice that struggled with frequent denials began working with Everest’s denial management team. Within three months, they saw an increase of 15% in recovered claims that had initially been denied, leading to significant revenue recovery.

4. Continuous Training and Staying Current with Industry Changes

Healthcare billing regulations and insurance policies are constantly evolving, with changes in coding rules, payer requirements, and compliance standards.  Everest A/R Management Group invests in ongoing training for its billing and coding specialists, ensuring they are up-to-date on the latest industry changes. This proactive approach minimizes errors due to outdated knowledge and helps maintain compliance with payer regulations.

Example: By staying ahead of industry changes, Everest helped a practice navigate new Medicare guidelines smoothly, avoiding potential denials that other practices faced due to unfamiliarity with updated policies. This proactive training initiative helped the practice maintain consistent reimbursement levels without facing unexpected denials.

 Everest A/R Management Group has developed a robust, multi-faceted approach to help healthcare providers reduce denials, improve accuracy, and increase revenue. By investing in eligibility verification, accurate coding, real-time claim scrubbing, an efficient denial management process, and ongoing training, Everest empowers practices to experience fewer claim denials and faster reimbursements. As the healthcare industry grows increasingly complex, Everest stands as a reliable partner dedicated to helping providers achieve financial stability and success.

These results demonstrate how the right billing partner can transform a practice’s financial health, allowing providers to focus on what matters most: delivering excellent patient care.