5 Key Strategies to Reduce Claim Denials in 2024

Healthcare organizations continue to face challenges with claim denials, which directly impact their revenue cycle performance. In this article, we'll explore five proven strategies to help reduce denial rates and improve clean claim submissions.

1. Implement Pre-submission Claim Validation

One of the most effective ways to reduce denials is to catch errors before claims are submitted. Implementing automated claim validation tools can help identify:

• Missing or incorrect patient information
• Invalid procedure and diagnosis code combinations
• Missing prior authorization requirements
• Non-covered services

2. Strengthen Insurance Verification Processes

Insurance verification is crucial for preventing denials. Best practices include:

• Verifying coverage before every visit
• Documenting all verification details
• Confirming specific service coverage
• Checking for prior authorization requirements

3. Maintain Updated Provider Credentials

Credential-related denials are often preventable. Key focus areas:

• Regular monitoring of expiration dates
• Timely submission of renewal applications
• Tracking processing timeframes
• Maintaining accurate provider profiles

4. Enhance Coding Accuracy

Accurate coding is fundamental to clean claims. Consider:

• Regular coding team training
• Implementing coding validation tools
• Monitoring coding patterns
• Conducting regular audits

5. Leverage Analytics for Prevention

Use data analytics to:

• Identify common denial patterns
• Track denial rates by payer
• Monitor appeal success rates
• Implement targeted improvements

By implementing these strategies, healthcare organizations can significantly reduce their denial rates and improve their revenue cycle performance.