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3 Actionable Tips for Reducing Claim Rejections

Disclaimer: This blog article was written by an AdvancedMD partner. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of AdvancedMD.

Reducing Claim Rejections | AdvancedMD

In an ideal world the end of the revenue cycle management process (RCM) would include a 100% rate of claims payment and a 0% rate of claims denials. Unfortunately, this is not the reality in which we live. However, there are many ways to strengthen RCM processes and identify certain common issues ahead of time in order to make this final aspect of the process run more smoothly.

How common are claims denials and rejections?

According to an American Academy of Family Physicians (AAFP) report, healthcare claims denials across the industry average between 5-10%. Medical claims rejections and denials can be the most significant challenge for hospitals and medical practices. Even the smallest medical billing and coding errors could be the reason for claim denials or payment delays.

What do claims denials cost healthcare providers?

A 2017 report by Change Healthcare found that the true cost of denied claims is $31.50. Claims denials can cause a lot of disruption to your revenue cycle workflows. This is the result of an average cost of $6.50 to file an initial claim plus the average cost to resubmit a denied claim at about $25.

How can providers prevent claims denials and rejections?

A 2014 Advisory Board study revealed that approximately 90% of claim denials are preventable, and most can in some way be linked back to making changes to the way claims are handled as part of the overall RCM process.

  1. Prevention: Creating a culture that focuses on preventing claims denials in the first place, rather than managing denials once they come in. Focus on ways in which an RCM can be optimized to ensure as few mistakes as possible and ultimately reducing the cost to collect.
  2. Automation: Manual claims management is still the norm for almost 35% of healthcare providers. Shifting to a more automated process ultimately saves time and money, by decreasing administrative costs on the front end and helping to ensure cleaner claims on the back end.

Integration: Rolling out a more streamlined and synchronized claims management process means more simplified and easier access to data and real-time analytics; this information is crucial to avoid claims being denied for common issues like medical coding errors.

How Via by Aquina strengthens provider RCM.

Via by Aquina gives your practice control over medical claims. Via is integrated into the claim’s management process for the sole purpose of expediting insurance reimbursements, so even when reimbursements are slow or claims are challenged, the bottom line is not negatively affected. With integration already in place with leading EHR providers such as AdvancedMD, getting started is easy.

To find out if Via is right for you and your practice, please visit the Via by Aquina Marketplace listing.

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Paul Thompson
Paul Thompson is currently National Account Manager for organic sales at Aquina Health. He has been working at Aquina since 2017 and has over 12 years of experience in management and sales in SaaS technology. As a healthcare finance specialist, Thompson is in charge of developing, creating, and executing sales strategies to prospects and existing clients. Thompson is also the primary point of contact for client support and growth initiatives with key strategic partnerships.


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