Infusion Pumps billing denials are constant annoyances that have a negative impact on your organization’s
- Cash flow
- Operational efficiency
Infusion Pumps billing denial rates in medical practices ranging from 5 to 10%, with better performers averaging 4%. Denial rates on first billing can reach as high as 15-20% in some organizations. 1 out of every 5 medical claims must be reworked or appealed by those providers.
Rework costs average $25 per claim, and success rates range from 55% – 98%, depending on the capabilities of the medical denial management team. When all fails, write-offs can vary from 1%-5% of net patient revenue. In a typical 300-bed hospital, 1% can amount up to $3 million per year, which is significant by any standard.
The good news is that many such Infusion Pumps billing denials are preventable. They may never be zero, but even a fraction of a percent reduction can have a significant impact on your organization’s bottom line.
Here are the top reasons for Infusion Pumps billing denials:
- Missing Data
A denial can be triggered by leaving just one required field blank on a claim form. 61% of initial Infusion Pumps billing denials and 42% of denial write-offs are due to demographic and technical errors, such as a
- Missing modifier
- Wrong plan code
- Social Security number
All these key factors, if missed can lead to the billing error.
- Duplicate claim or service
The most common reason for 32% of Medicare Part B claim denials is duplicated. These are claims resubmitted for the same service; on the same date; by the same provider; for the same beneficiary; for the same service item.
- Not covered by payer
One needs to check information in the insurance eligibility response or contacting the provider before administering services. This will prevent Infusion Pumps billing denials for procedures not covered by the patients’ current benefit plans.
Dealing with denied Infusion Pumps billing claims is an important part of revenue cycle management. Relying solely on it can cause cash flow to become dangerously low. Proactively measuring the volume and causes of denied billing claims so that they can be avoided before they happen is a much more sound financial approach.
Way to avoid Denials of Infusion Pumps Billing Claims
- Create a task force to examine and prioritize denial trends. Determine the resources required to implement solutions, and monitor and report progress.
- Improve the accuracy of patient data at registration. This is the prime reason of many errors and, eventually, denials.
- Develop a denials prevention mindset across the board. This includes:
- Patient accounting
- Case management
- Medical records
- Patient access
- Optimize your claims management software to make sure that edits are working properly, are up to date, and are improving your clean claims rate. Your vendor should provide clean claims rate data on a regular basis, as well as tips on how to improve it that are tailored to your company.
- Use automated predictive analytics to identify and address potential denials before claims are submitted.
- Collaborate with payers to eliminate contract clauses that frequently result in denials being overturned on appeal. Again, data analytics can assist in identifying problem areas and facilitating negotiations.
Hence to conclude, many hospitals and practices lack the technology and staffing necessary to effectively manage denials, especially given the ever-changing regulations and payer rules.
Outsourcing revenue cycle management to experts, particularly those with dedicated denials management teams, can be a cost-effective and long-term solution. They assist with setting Infusion Pumps billing benchmarks, reducing backlogs, identifying root causes of denials, and supplementing your revenue cycle team.