Denied insurance claims: What you need to know to get paid

One way you can make a significant difference in your bottom line is by following up with insurance companies on unpaid claims. Not only will taking the time to regularly and thoroughly review denied claims put more money in your pocket, but it will put you in the good graces of your providers and help you avoid similar issues in the future.

Dedicated accounts receivable staff members are responsible for maintaining a database and setting up a schedule and process for following up on denied claims. While it can be time-intensive and require serious organization, it’s well worth it when reimbursement comes through. Following up on these claims is also critical for keeping the revenue process moving and help mitigate cash flow issues. To ensure optimal efficiency, the accounts receivable team should be experienced, well trained, and encouraged to identify trends in the internal billing processes, leaving room for strategic decisions to help avoid future issues.

Learning from past denials is key to avoid repeating mistakes, but it’s also important that communication is clear and consistent among staff members, including physicians, to avoid possible errors on a claim that could result in a denial. Billing codes also change, making staying up to date on new or modified codes essential to reducing and avoiding mistakes. Automating as much as you can, especially when it comes to diagnostic codes, will save time and help avoid simple mistakes from human error, affording the billing team more time to ensure complete and accurate information is submitted. This is particularly important as insurance companies’ instructions for resubmitting a claim may involve different processes and forms.

Be on the lookout for common billing errors, including:

  • Inaccurate provider and/or patient information.
  • Incorrect, missing, conflicting and/or nonspecific codes.
  • Duplicative billing.
  • Missing information (e.g., the provider’s W-9 or authorization number).


For more information, contact HCM today to see how we can help. 



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