How do you prevent claim rejections due to missing or invalid patient information?

I tend to work using the GIGO method-garbage in, garbage out. It all starts with insurance verification and without that piece, you're sitting there looking at an aging report wondering why claims that should've paid in less than 30 days are now sitting in your 90 day bucket. Knowing how to do it, what information to gather, where to get it from and that's not necessarily the patient. Most people don't understand their benefits so it falls on those of us who do understand to make sure we get the best information we can, get it entered correctly and then keep your fingers crossed!

Printing demograohic sheets for every patient before their visit and having them initial them as accurate is appropriate as well. If tablets are available, they can verify and update as wel.

At the time of the visit (or scheduling process), the front-end RCM department takes a crucial role here to collect, validate, and enter accurate information in the billing system. There should be a refreshing or learning session for the staff on a periodic basis to make them understand the impact of incorrect dates and how they will affect the entire RCM process. If we can have an automation tool and scan the patient ID and insurance ID details and fetch the information through the scanning process, that would be a suggested point.  And educate the members with the correct information during each and every visit.  Validating the eligibility and the covered service details will also be an optimal way to reduce the denials.

In my experience verify - patient ID - insurance card - physician orders if applicable and Diagnose code Front end staff should verify patient demographic’s information from accounting system with patient insurance ID card Patient benefits coverage

You should at least ASK at every encounter if there have been any changes in address, insurance, job, fiscal responsibility for med expenses. This is a MUST for behavioral health (PHP, IOP, ABA) encounters, because benefits exhaust faster and in many instances leads to new insurance plans. In other instances, the coverage ends with no replacement. These are frequent visit patients, so balances rapidly accumulate. Prevent re-work. And bad debt . . .

When verifying contact information, ask open ended questions for example, can you provide your address and what is the best number to reach you? This provides a better opportunity to receive accurate information, versus asking for partial information or restating a full address for example, where are you provide the patient the opportunity to just say. Verify eligibility prior to the visit, scan ID and insurance card, front and back when the patient checks in at the time of service.

If not using an online tool to allow patient real time data updates, ask patient on check if they still live at "x street" and if their valid phone number is "xxx" upon check in to every visit. Obtain full patient information requests a minimum of each year to allow for changes in contacts and other information such as insurance changes.

Establish processes to verify patient information at the point of service or during registration. Ensure that all necessary demographic and insurance information is collected accurately and completely.

The Power of Simplicity- Validating Patient info! Amidst complex solutions, we found simplicity in Prior Authorization which structures patient information gathering process. It’s often overlooked, but its influence on streamlining financial operations cannot be understated. The simplicity and structured approach to Prior Authorizations stood out. • Enhanced efficiency- Organized way • Minimized errors, lesser claim denials • Significantly improved revenue flow. We learned that sometimes the most impactful solutions are the ones hiding in plain sight. It's time to give credit to an unsung hero in reducing claim rejections in medical billing and a significant catalyst of the revenue cycle management process- "Prior Authorization"

Allow your revenue cycle management system or a third party vendor to allow real-time eligibility before and on the date of service. Use group numbers or other appropriate data that may allow a payer to route a claim to the proper department for processing.

Businesses that prioritize accurate patient information experience fewer rejections, leading to improved cash flow. As an experienced medical billing-RCM team with 10+years of reliable service, we at RND SOFTECH share the common goal of financial success and supporting top-notch patient care. 1. Conducted regular training sessions for staff on accurate data entry. 2. Implemented technology based solutions that flag potential errors before claims are submitted. 3. Established a systematic process for verifying patient information at intake and throughout the revenue cycle. Our RCM team now operates seamlessly, maximizing revenue and ensuring a positive patient experience.

Certified Professional Coders are exceptional at analyzing medical records and assigning appropriate coding to maximize revenue allowing for less payer rejections. Front office staff should work in conjunction with the AR team for consistent training on verifying appropriate patient insurance coverage. Use a system with a built in charge scrubber to review for possible denials before claim submission.

Provide comprehensive training to staff members responsible for patient registration and data entry. Emphasize the importance of capturing complete and accurate patient information to prevent claim rejections.

Analyze claim rejections on an end of month basis to determine where areas of improvement exist and make the appropriate departmental corrections to avoid a continuance of claim rejections for this same reason through team training.

Conduct regular audits and quality assurance checks on claims data to identify patterns or trends related to claim rejections. Use this information to refine processes and address recurring issues effectively.

Invest in technology solutions that automate data entry processes and minimize manual data entry errors. This can include optical character recognition (OCR) software or integration with electronic health record (EHR) systems.

Suggestions for a couple of other proactive front end steps to reduce denials and re-work : 1) work w periop staff to make authorization updates of DX and procedures performed real-time (or next day) 2) in surgical scheduling, use automation or "cheat sheets" of at least the most frequently performed procedures to assure office- provided diagnoses support med necessity for the scheduled procedures 3) Similarly, automated affirmation of med necessity in diagnosis to procedure mapping should exist in encoders and bill edits. - in 99.9 % of the time it exists, but may be overlooked in the documentation process. Again, save time and costs of re-work and accelerate cash.

Offer feedback and education to staff members based on claim rejection trends or patterns. Provide targeted training or resources to address common errors and improve performance.

Track KPIs related to claim submission and rejection rates, focusing specifically on rejections due to missing or invalid patient information. Use this data to measure progress over time and identify areas for improvement.

Implement batch verification processes to validate patient information against payer databases in bulk. This can help identify and correct errors or discrepancies across multiple claims simultaneously.