Managing the expenses of your fertility clinic can be difficult if you have a broken billing system. Denials will be higher, there will be cases of delayed reimbursements, and of course deteriorated functionality of the clinic.  

 

Establishing a definitive fertility billing framework is therefore essential to prevent claim denials and revenue loss.  

 

Denials of medical claims are the easiest to identify, handle, and fix. You can create a comprehensive plan to fix the issues that will enhance your company's income flow by determining the reasons for denials and which one is most financially necessary to address first.   

 

To cut down on claim denials and recover lost revenue, follow these seven steps:   

 

• Check your patients’ insurance and eligibility  
• Examine the payor's contract  
• Do a denial management evaluation   
• Understand your payors' policies  
• Put your denials into categories  
• Examine, evaluate, and keep an eye on   
• Make a denial management strategy and put it into action  
• Claim Denials in Fertility Billing  

Over the last five years, fertility clinics' denial rates have increased by more than 20 percent, with average claims denial rates of 10 percent or higher.   

 

In 2021 alone, survey participants reported an average rise in denials of 17%, according to a Medical Group Management Association (MGMA) Stat poll.   

 

According to industry averages, up to 60% of returned claims are never resubmitted, and approximately 20% of all claims are rejected.   

 

The expense of reworking or appealing denials, which average $25 per claim for practitioners and an astounding $181 per claim for hospitals, further reduces the bottom line.  

 

In the healthcare sector, the typical claim denial rate is between 5 and 10%. Every year, denials cost many healthcare providers thousands of dollars in lost income.   

 

A strong denial management system's latency is the cause of these denials.   

 

Nearly 65% of rejected claims are never resubmitted, costing healthcare providers money they will never get back.  

 

To mitigate the financial risks of your fertility clinic, you can implement the following strategies-  

 

24% of claims are rejected because they are ineligible. More often than you would think, people switch employment, insurance plans, and locations.   

 

You must verify a patient's insurance eligibility on every visit. It doesn't matter whether the patient is regular or seeing you for the first time, staying comprehensive with the patient's coverage benefits is essential to obtain accurate reimbursements.  

 

Your employees should be able to explain coverage benefits to patients, translate the policy, and comprehend the plans you accept.   

 

Many claims are rejected due to inadequate documentation, missing information, or inaccurate data.   

 

To file clean claims, you need to be aware of the payers and their requirements. Payors have their own rules and specifications for submitting claims.   

 

To understand the payer's specific needs, you need to draft an overview. Make use of the following information to create a thorough payors’ requirements summary. 

• Format of the payor   
• Timeframe for submitting a claim   
• Duration of reimbursement   
• The method of submitting a claim   
• Supplementary documentation   
• Helpline number for emergencies   

‍How successfully you handle denials affects your clinic’s revenue cycle process. You need to examine the claims that have been filed within the previous 12 months.   

 

You may find out how many claims were submitted overall compared to how many were denied by using denial analysis. The amount of money lost because of denials is understandable. This is a quick denial management test that you can use.    

 

Wrapping Up  

 

You can list the top categories for revenue loss and create different subcategories for each. Then you can list the methods to combat denials from subcategories and start implementing changes.   

 

Also, you can consider the above-mentioned strategies as per your practice needs.   

 

However, outsourcing of fertility billing services has emerged as a plausible solution to the providers in the last few years.   

 

A reliable outsourcing company has a team of expert medical billers and coders who have extensive knowledge of fertility billing guidelines and regulations.   

 

Handing over the administrative tasks to a company like this reduces the chances of errors in the billing and coding process thus increases the chances of accurate and timely reimbursements.   

 

Choosing the right outsourced fertility clinic billing is a crucial decision for your practice. Find a company that can improve your ROI in the long run and sustain functionality of your practice.