#Medicare

How Medicare claim denials can be affecting your medical facility

Shayla Ebsen
|Jul 14|magazine11 min read

Has your health care facility recently been plagued by an onslaught of Medicare claim denials? You aren't alone. It's a problem that has been happening more frequently, but what's the cause?

Overall, the increase in claim denials is linked to health care facilities submitting claims that followed outdated guidelines. Here is some insight into what may be causing your facility's increase in denials and how to correct the situation.

Track changes in claim requirements

You can't properly avoid Medicare claim denials if you aren't informed of the latest changes in claim guidelines and rules.

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Assign someone in your facility with the duty of staying current on the latest Medicare changes and ensure that any changes that affect your claim submission process are filtered down to relevant affected employees.

Ask for current information

A proactive measure you can take to reduce the number of Medicare claim denials in your health care facility is asking each patient to present an up-to-date Medicare card.

By asking for current Medicare information, you can verify that it matches the copy in your records and, most importantly, that you have the current information needed to submit a valid Medicare claim.

If patients aren't happy with the change of being asked to present their Medicare information at each visit, explaining that it's a new policy to avoid claim denials should help.

Understand provider issues

According to the article “A basic guide to reducing Medicare claim denials,” many facilities are currently receiving claim denials because a “referring provider cannot order or refer.”

This denial is most typically linked to a 2014 change in the rules from the Centers for Medicare and Medicaid Services.

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This rule change now means that Medicare will deny certain types of supplies and equipment if the ordering or referring physician isn't identified properly or isn't enrolled in certain Medicare systems.

Follow up fast

A common practice in health care facilities is to allow a stack of claim denials to build so that employees can deal with them at one time in bulk. However, this could be hurting your facility.

Instead of letting the denials pile up, set a new standard of dealing with them immediately.

By dealing with a denial right away, you won't forget the details associated with it and your revenue will be less affected in the long term because denials will be resolved sooner.

Inform your staff

Communication is key when trying to reduce the number of Medicare claim denials that come back to your health care facility.

Staff members who submit claims must remain informed on changes in Medicare guidelines and rules. They must also have the training needed to properly submit claims.

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If your investigation into why denials are happening shows that staff members haven't been properly trained or informed on guidelines changes, make the necessary policy changes to correct the situation.

Don't let an uptick in Medicare claim denials affect your health care facility's revenue.

Instead, investigate the sources of the problems, take swift action to correct the troubles and set a new standard for keeping current with Medicare claim guidelines.

About the author: Shayla Ebsen is a freelance writer and editor with more than 10 years of professional writing experience both in the corporate and freelance settings

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