The Simple Explanation of Denial Avoidance

In this article, we will discuss how denial avoidance works, and how you can implement this key tactic for your own medical practice.


How Do Claims Work?

In order to understand how denial avoidance works, it is important to have a basic understanding of how claims are processed. When a patient receives care from a medical provider, the provider will submit a claim to the patient's insurance company.


The insurance company will then review the claim and determine whether or not they will pay for the services that were provided.

Picture of insurance claim form and calculator.

There are many factors that go into this decision, but one of the key things that insurance companies look at is whether or not all of the required information was included in the claim. If any information is missing, it may result in the claim being denied.


This is where denial avoidance comes into play. By taking specific steps to ensure that all required information is included in the claim, you can increase the likelihood of the claim being approved.


What Are The Steps Of Denial Avoidance?

There are four key steps that you should take in order to avoid denials:

  • The first step is to verify that the patient is eligible for the services that they are receiving. This can be done by checking with the insurance company or by using an eligibility verification service.

  • The second step is to make sure that all of the required information is included in the claim. This includes things like diagnosis codes, procedure codes, and dates of service.

  • The third step is to submit the claim in a timely manner. Claims should be submitted as soon as possible after the patient has received care.

  • The fourth and final step is to follow up with the insurance company if the claim is denied. This allows you to appeal the decision and potentially have the claim approved.

Need Help Avoiding Claim Denials?

By taking these four steps, you can significantly increase your chances of getting paid by insurance companies. Implementing a denial avoidance strategy is an essential part of running a successful medical practice.


To learn more about how to avoid future claim denials, contact us today to learn about our streamlined billing solutions.


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