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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Comprehensive Approach for Denial Management

Denied claims offer lots of challenges for any practice owner. Your billing staff is already busy verifying patient and insurance data and trying to submit clean claims. And when claims are denied, they have to work on these denied claims once again from the start. Ideally, when you submit 100 claims, not more than 10 […]

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Analyzing Claim Denial Trends for 2020

Hospitals are receiving more claim denials from payers, with the average rate increasing by 23 percent in 2020 compared to 2016, according to a research report conducted by Change Healthcare. The analysis includes 102 million hospital transactions valued at $407 billion in total charges across more than 1,500 U.S. hospitals. Since 2016, the denial rate […]

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Implementing Preventive Denial Management

According to the denial rates report published in February 2021, out of total claims submitted worth $3 trillion, claims worth $262 billion were denied. You will be surprised to know that more than 90% of these denials are preventable. And the worst part is, more than half of these denials were never appealed or resubmitted […]

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Guidelines to Submit a Clean Claim

Defining Clean Claim  A clean claim is a submitted claim without any errors or other issues, including incomplete documentation that causes claim rejections or denials. As per the definition of a clean claim first part is correct to claim information and while the second part is not missing any information. In this blog, we shared […]

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What are the most common errors when submitting claims?

Have you ever checked how accurate claims are being submitted by your medical billing department? Due to the complex medical coding system, it is not surprising that errors are possible. A small error may lead to denial which ultimately impacts overall practice revenue. Let’s discuss common errors when submitting claims in detail. Every practice has […]

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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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