Numerous factors can cost your practice revenue and profits. Any mistake in any step of the billing process could result in delayed payments and claim denials. 

Fertility practices are closely woven with gynecology and obstetrics practices and there are numerous claim submission and coding requirements within the billing process. 

With the increasing patient volume and evolving claim submission requirements, it is becoming difficult for the providers to sustain a defined fertility billing and coding process which is resulting in claim delays and denials. 

Instead of focusing on claim management, experts suggest concentrating on areas where potential errors are occurring in your fertility billing practices. 

Before you try to prevent denials in your practice, you must understand the complexities of the practice.

Denial management requires you to assess your practice’s performance and find the root cause of denials. However, before getting into the introspection of your practice, it is important to note that denials do not happen due to a single cause. Numerous disruptions within the billing and revenue cycle management process result in claim denials and revenue loss.

An internal audit might help you to analyze and track the current fertility billing practices and target the areas of problems. Furthermore, you can explore the denial reasons and patterns exclusively which will be more helpful in making an informed decision regarding denial prevention and management. 

Here are some tips through which you can improve your fertility billing practices and prevent denials- 

1) Streamlined coding and documentation: Accurate documentation and coding are paramount to prevent denials and fertility practices are no exception.

You must ensure there are no missing pieces of information or inadequate information within the documents. Furthermore, from prior authorization approval to proof of medical necessity all should be documented in an organized manner. 

On top of that, you need to evaluate the coding requirements and implementation before submitting claims to the payors to avoid claim rejections and denials. 

2) Thoroughly assessed insurance eligibility: One of the most common reasons for claim denials is the ineligibility of the patients to avail themselves of the services. More than 20% of the denials happen due to a lack of patients’ insurance eligibility. 

Having a dedicated staff who is working on patient’s insurance eligibility verification can ease the pain points of claim denials. 

3) Well-defined appeal protocol: Another important part of claim denials in fertility billing is not always a problem on your part. 

Some claims may fall through the cracks or may be denied due to the payors’ part. These claims cost you substantial revenue loss and even after correction and resubmission can bounce back. 

You need to establish a structured denial management system within your fertility clinic to ensure everything falls in place. 

3) Technology: The advent of technology is a boon for medical billing services. While understanding and implementing updated billing software in your fertility clinic is tough considering the time, training, and costs required for the same, partnering with a third-party organization can help you implement the right software for your practice. 

Outsource Your Fertility Billing and Denial Management Processes

Handling fertility billing and revenue cycle management is tough with increasing intricacies in claim submission guidelines and coding regulations. 

On the other hand, the competitive market, surging labor wages, and scarcity of skilled workforce make it difficult for the providers to sustain an in-house billing and denial management team. 

If you have identified that you have numerous errors in billing and coding processes that result in denials, then it is the right time to outsource your fertility billing services and denial management processes. 

Implementing advanced processes and technologies like robotic process automation within tedious aspects like prior authorization and AR management of the outsourced experts can reduce errors and administrative burdens. This will leave you with more room for effective patient care and improved quality of services, while the experts will sustain your practice’s financial stability.