Tackling Ever Increasing Claim Denials

Increasing Claim Denials Recently Kaiser Family Foundation published an analysis on claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace payers need to report claims denial data and this analysis used the same data to understand claim denial status. The analysis found that, overall, nearly one out of […]


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How to Manage Common Denials for RPM?

Remote Patient Monitoring (RPM) is a health care delivery method that benefits patients, providers, caregivers, and the healthcare system as a whole, by leveraging technology advances to gather patient data, outside of traditional health care delivery settings. From increasing access to virtual care, increased patient-provider communication opportunities, and improved patient involvement in self-management to reducing […]


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Adopting Proactive Approach to Reduce Claim Denials

Claim denial occurs when a claim is submitted by the healthcare provider and is not accepted by the payer. Most practices face the challenge of high claim denials. You would be surprised to know that the highest performing medical practices have only a 4 percent denial rate (as per the Medical Group Management Association survey […]


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Effectively Handling Claim Denials

In a perfect world, all submitted claims would be processed correctly the first time. In the world of medical billing, however, we know this is not always the case. Even after cautiously submitting a claim it may get denied. Handling claim denials can be a frustrating, time-consuming, and complicated process. Knowing some basic strategies for […]


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Manage Coordination of Benefits (COB) Denials

Centers for Medicare & Medicaid Services (CMS) defines coordination of benefits (COB), as the process which allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities. In simpler words, COB determines which insurance carrier is primary, secondary, and so forth. This coordination between insurance carriers exists […]


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Avoiding Medicare/Medicaid Crossover Claims Rejections

If your Medicaid crossover claims are rejecting it may be due to the address you have on file with Medicare and Medicaid. When Medicare crosses over your claim to Medicaid, address fields like Master address and Pay-to (or remit address) are submitted. If Medicaid does not have the same addresses in their file, Medicaid will […]


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How to reduce hospital claim denial rates in 2021?

The recent COVID-19 pandemic has accelerated claim denials from payers. According to a recent analysis, the average rate of claim denial is increasing by 23 percent in 2020 compared to four years ago. Faults related to missing or invalid claim data, which included unspecified billing issues, missing or invalid explanation of benefits, and service not […]


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Diagnostic Medical Coding and Reporting Guidelines for Outpatient Services

These coding guidelines for outpatient diagnoses have been approved for use by hospitals/ providers in coding and reporting hospital-based Outpatient Services and provider-based office visits. The terms encounter and visit are often used interchangeably in describing Outpatient Services contacts and, therefore, appear together in these guidelines without distinguishing one from the other. Though the conventions […]


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Avoiding Claims Denials for OB/GYN

Denials are a thorn in the flesh for most medical practices. But there are some specialties that have an exceptionally high denial rate. OB/GYN is, unfortunately, one of them. Denial rates in this specialty are the highest at a whopping 22.42%. Denials are an everyday occurrence for most OB/GYN centers. OB/GYN billing and coding comes […]


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