The factors that affect the revenue cycle is when the claims are denied. In the entire process, it is important to identify if there is a certain percentage of denials that will occur due to some reasons. By following a few simple steps and thoroughness in the work, the healthcare providers can lower the rate of denial.

• Getting prior authorization for every service required minimizes certain types of denials. By doing so, the staff can work to make sure that each patient has the insurance available and the service can be delivered as there is a surety of insurance coverage.


• The staff should check the eligibility of each patient, their coverage and benefits before a claim is submitted. This means inquiring the patients if their coverage has changed and if they have the ability to verify their current coverage.


• One of the major reasons for the claims to be denied is because of the simple coding errors like wrong or outdated codes that may be used to identify the service. The recent ICD-10 transition, there is an apparent rise in errors. Therefore, the new codes will need an easy access and also double-checked, so that mistakes can be avoided.


• It is essential to have good proofreaders in order to find the mistakes before they result in more denials. It is like a quality check. There is a possibility that proofreaders can actually find the mistakes if they have not filled the original ones.

It is helpful to execute a proper denial management program that can reduce mistakes and other issues that can avoid a possible rejection.

Chirag Patel
VP - Corporate Communications
chiragb@promantra.us
Phone: +1-732-414-3678