Speaker 1: In 2023, nearly 18% of insured individuals experienced a denial claim. Denials in medical billing are quite common. While there are precautions you can take to avoid denials, they aren't completely preventable. For this reason, it's important to know what to do in the event that you receive a denial. A denial happens when an insurance company or other carrier denies a request for coverage on healthcare offerings or services for a patient from a professional. The back-and-forth processes between fixing denials can be a meticulous process. If not dealt with properly, it can cause practices a lot of lost revenue. In the case that you receive a claim denial, let's go through five steps on how to handle it. Step 1. Review. The first step to handling a denial is to understand why it happened. Although this step seems pretty straightforward, it can get pretty confusing if you don't know what to look for. When an insurance company or carrier denies the claim, they have to provide an explanation as to why the denial was not accepted. This is where you will find the denial code. Denial codes are an explanation as to why insurance cannot cover a patient's treatment costs. With this explanation, medical billers can resolve and resubmit the claim. Once you are able to understand how the claim became a denial, you are able to move forward with the next step. Step 2. Revise. Now that you have carefully reviewed the denial, you know the necessary corrections that need to take place. This could be adding information or fixing grammatical errors and misspellings. These changes will give the insurance company a better understanding of what exactly you're requesting coverage for. Examples of additional information that can affect a claim's status are a patient's medical records, test results, or proof of a patient's treatment progress. Step 3. Request appeal. With an understanding of why your claim was first denied and then making the appropriate revisions, you are able to move to the next step and make your appeal. So what is an appeal? An appeal is a formal request to an insurance provider to review the denial claim. There are two types of appeals, internal appeal and external appeal. An internal appeal involves asking the insurance company to reconsider its decision now given the revised request for payment. An external appeal is taking the denial out of the insurance company's hands and having the claim externally reviewed by a third party. Step 4. Reach agreement. Once you've submitted your appeal, it's in the insurance company's hands for review. Depending on the denial and the revised changes, either the insurance will accept your claim or they will continue to deny it. If they accept it, yay. If not, don't lose hope yet. You can repeat the previous steps and revise the claim again. The provider will continue to provide you with reasoning as to why the claim was not accepted. This step might take a while in the process due to going back and forth between your healthcare practice and the insurance company. So what can we do to try to avoid this as much as possible? Let's go into our fifth and final step. Step 5. Re-institute preventative processes. Denials coming back to your organization are signifiers of process improvement. In other words, they're telling you that there are fixable errors in your claim submission process. Once you fix the bottlenecks in your claim submission process that lead to denials, you'll decrease the amount of denials you receive and increase your revenues. Knowing how to handle denials efficiently and effectively means less money out of your pocket and also allows you to spend more time actively working within your field than having to worry about the back-end side of things. Denial management is important. While there are precautions you can take to avoid denials, they aren't completely preventable. Handling denials can be frustrating and costly, but you don't have to do it on your own. Partnering with the clearinghouse company not only speeds up the collection process, but allows for better administrative efficiency. If you'd like to learn more about handling denial codes, click the link in the description to this video or reach out to eTactics. And you already made it this far into the video, so you might as well like it, share it, and comment below.