Claim denials don't just hurt financially. When therapists and staff are bogged down with billing issues, there's less time for patient interactions, which can lead to an increase in stress for both staff and patients. Here are some of the most common reasons therapists get denied for claims.

Incomplete or Inaccurate Patient Information

One common reason for claim denials is incomplete or wrong patient information. This can include missing or incorrect insurance details, outdated patient information, or errors in patient identification. These small mistakes can cause big delays in payment and more administrative work.

Lack of Prior Authorization

Not getting prior authorization for services is another frequent cause of claim denials. This often happens because of misunderstandings about insurance requirements or changes in insurance policies. It's important for therapy practices to stay updated with the latest authorization requirements for each insurance provider they work with.

Coding Errors and Omissions

Getting coding right is crucial for successful claim submissions. Common coding mistakes include using the wrong CPT or ICD-10 codes, mismatching diagnosis and procedure codes, and unbundling codes. These errors can cause claim denials or underpayments for the services you provided.

Medical Necessity Issues

Insurance providers might deny claims if there's not enough documentation to show that therapy was needed. This includes unclear treatment goals or inadequate progress notes. Making sure all your documentation clearly shows the medical necessity of the services you provide is key to avoiding these denials.

Timely Filing Violations

Many insurance providers have strict deadlines for submitting claims. Missing these deadlines can lead to automatic denials. Delays in following up on pending claims and not being aware of different payer timelines can also cause timely filing violations.

Strategies to reduce denials

Implement Robust Verification Processes

To cut down on claim denials from incomplete or wrong patient information, put robust verification processes in place. Double-check patient details at each visit, regularly update insurance information, and use automated eligibility verification tools to ensure everything is accurate.

Prioritize Prior Authorization

Create a checklist for services that need pre-approval and set up a system to track authorization deadlines. Educate your staff on why prior authorization is important so this crucial step isn't missed.

Enhance Coding Accuracy

Invest in ongoing training for your billing staff to keep them updated with the latest coding guidelines. Use coding software with built-in error checks to catch mistakes before submitting claims. Regularly audit your coding practices to find and fix any recurring issues.

Strengthen Documentation Practices

Set clear guidelines for documenting medical necessity. Use standardized templates for progress notes to make sure all required information is consistently included. Implement peer review processes for documentation to maintain high standards across your practice.

Optimize Claim Submission Timelines

Create a calendar to track filing deadlines and set up automated reminders for pending claims. Develop a quick response plan for denied claims to make sure they are handled promptly and within payer deadlines.

Take a look at how MyWellBeing, a therapy practice with multiple locations, was having trouble with denials until they implemented Arrow Intelligence.

Empowering Therapists to Focus on Care

Understanding and tackling the common reasons for therapy claim denials is essential for your practice's financial health. By setting up strong processes and using advanced technology, you can cut down on denials, improve your cash flow, and spend more time on what really matters – giving great care to your patients.

To learn more about how Arrow Intelligence can revolutionize your therapy practice's revenue cycle management, contact us today for a personalized demonstration. Take the first step towards optimizing your revenue cycle and ensuring the financial health of your practice.