A Comprehensive Guide to Resolving Claims Rejections: Master Billing LLC’s Key to a Streamlined Revenue Cycle

At Master Billing LLC, we understand that no provider should have to endure cash flow issues after putting in so much hard work and effort. However, medical claims, if not managed properly, can lead to just that. Similar to a tree’s growth, practice revenue flourishes when its needs are met in the right proportion, and adhering to proper coding and billing guidelines is crucial for success.

The first stage in revenue cycle management is pre-submission scrubbing of claims, setting the foundation for a successful billing process. This includes verifying eligibility and benefits, updating patient and insurance data, and adhering to payor specific constraints.

Medical claim filing is a labor-intensive process, from screening claims for errors to their actual submission to payers. Moreover, the subsequent steps after claim submission, such as tracking and following up with payers, can be equally challenging. Facing claim denials only exacerbates the situation, making it imperative to understand claim rejections in detail.

Denials Differ from Rejections! Then What Are Claim Rejections?

Understanding the difference between claim rejections and denials is essential. Contrary to common belief, not all rejected claims are denied! Let’s delve into the basics of claim rejections.
Rejected claims, according to payers, are non-compliant with their standards. Unlike denials, rejected claims can be reworked and corrected for final submission to payers. To assist you in this process, clearinghouses play a pivotal role by reviewing your claims and providing valuable feedback in the form of rejections. It’s important to note that clearinghouse rejection does not mean that your payer will not reimburse the claim.

At Master Billing LLC, we understand the significance of integrated clearinghouses, such as the one offered through our partnership with AdvancedMD. These advanced practice management systems automatically submit claims to the clearinghouse for final scrubbing before presenting them to your payers. With this integrated approach, you can avoid submitting and tracking clearinghouse rejections in multiple systems, streamlining the billing process.

Begin By Passing Through the Clearinghouse The advantage of clearinghouse rejections over payer rejections is quite evident when considering the enormous workload that insurance firms handle. With millions of claims to process, insurance payers face significant challenges in keeping up with the volume of claims.

Clearinghouses act as an efficient bridge between you and the payer. By detecting and addressing mistakes, they ensure that your claims are in optimal shape for final submission. Unlike payers, clearinghouses provide faster rejections, allowing you to address issues promptly and avoid delays in payments.

Two Advantages That Clearinghouses Provide The first advantage of using a clearinghouse is the speed at which they operate. Given the sheer volume of claims processed by payers, waiting for their rejections can be time-consuming. Clearinghouses, on the other hand, offer quicker rejections, allowing you to take action promptly.

The second advantage lies in the records maintained by clearinghouses. Unlike payers, clearinghouses keep track of rejected claims and provide details whenever needed. This historical data is valuable for identifying patterns and improving your claims submission process.

Numbering 12 Reasons for Rejecting Your Claims To help you understand why your claims may be rejected, we have compiled a list of the most common reasons in order of frequency:

1. Provider enrollment with payers not completed before claims submission.
2. Inappropriate subscriber ID format.
3. Inaccurate configuration of CPID and Payor IDs.
4. Use of invalid or deprecated codes due to coding regulation changes.
5. Missing adjudication date or payment date in a COB claim.
6. Incorrectly stated alphanumeric Subscriber Group or Policy Number.
7. Wrong zip code used in the subscriber loop.
8. Failure to include the primary payer’s paid amount in the Medicare Secondary Payer claim.
9. Missing mention of the specific claim’s unique Internal Control Number (ICN).
10. Improper procedural code assignment.
11. Gender-specific invalid diagnosis code (ICD10) given.
12. Incorrectly provided group number and Policy number (Both are different from each other).

Common Claims Rejections and Confusions Claims rejections usually stem from two common reasons:

1. Information provided by the provider does not match the insurance payer’s records.
2. The data does not comply with the regulations or standards outlined by payers.

At Master Billing LLC, we understand the significance of clear communication with payers and staying up-to-date with coding regulations. Our knowledgeable team can help you navigate these complexities and ensure smooth claims submission.

1. Identify rejections saved at the clearinghouse.
2. Thoroughly examine the claims and make necessary modifications.
3. Resubmit the corrected claims for a final review to the clearinghouse.
4. Submit the revised claims to payers for payment.

Remember, clearinghouse rejections serve as an additional billing step and a shield against potential denials. Embrace them as an integral part of your billing process.

Bottom Line Just as a child requires support to take its first steps without falling, you need the assistance of outsourcing companies to ensure your billing stands tall. At Master Billing LLC, we take pride in providing top-class RCM services tailored to your needs, resolving persistent payment concerns.

Partner with Master Billing LLC, and benefit from our partnership with AdvancedMD, offering comprehensive solutions for all your RCM needs. With integrated clearinghouse functionality, claims scrubbing and eligibility checks become a seamless process. Say goodbye to denials and contact us today at [email protected] for more details. Let us pave the way to a streamlined and successful revenue cycle for Master Billing LLC.