October 30, 2013
In case of claim denials, every medical practice goes through the time-consuming procedure of dealing with a health insurer. Claim denials create a cash flow problem for practices due to which it becomes essential for providers to minimize delays and denials.
Simplifying the appeal process:
Physicians should appeal a denied claim even if it is for recovering a small amount. There are certain strategies for ensuring the success of the appeal process. Physicians need to find out the reason behind denial of coverage and understand the appeal procedure of their insurer.
Various interactive resources have been introduced by the AMA for simplifying the process of appeals and claim audits for physicians.
In case of administrative denials caused due to paperwork errors, even a simple phone call to the health plan’s office can solve the problem. However, for clinical denials where the medical necessity of a treatment or procedure is questioned by the insurance company, a lot of paperwork needs to be done in a certain timeframe for submitting an appeal
Before getting into the procedure, it helps to ensure that the service you will be appealing for is not specifically excluded from the patient’s health plan contract.
Review the documentation and coding based on the guidelines before filling an appeal letter. Practices should be prepared with sources that support their treatment plan
Physicians need to know the different levels and time frame of appeal for each health plan
A log needs to be organized for all the denials in last 6-12 months to know the reason behind each denied claim. For instance, coding errors can be one of the reasons why all health plans will deny a service
Don’t let denied claims affect your revenue cycle:
One of the best ways to maximize revenue of your practice is to appeal denied claims and collect payment for all services you have provided. However, you need to follow the above mentioned procedure in a proper manner to ensure timely collections.
At times, practices don’t pursue appeal due to lack of time and commitment of the staff. Simple denials can be handled on the phone but complicated denials require extensive staff training on coding issues. Expert coders will have to be hired and in-house staff will have to be trained on how to make an appeal and to know what services can be billed for and how.
If you are facing these challenges, hiring a billing partner can solve your denial issues. Services offered by companies such as Medicalbillersandcoders.com ensure that limitation of time and money doesn’t affect reimbursement for practices.
At MBC, expert team of coders and billers work towards increasing revenue flow of practices by reducing claim denials. By availing our medical billing services you can eliminate the headache of filing and re-filing claims, following-up with insurance companies, meeting coding challenges, HIPAA compliance and various administrative challenges that affect the financial health of your practice.
Accounts Receivables / Claims Denials