Be on the lookout for clues to submit a successful appeal. Denials and appeals can be the most frustrating parts of a coder’s job. I have been on both sides of the fence — working pro-fee for a healthcare system, handling denials, and working for a payer, looking at denials. In my experience, there are ...
In Audit
Nov 1st, 2018
By law, the Administrative Law Judge level of Appeals has 90 days to resolve appeals submitted to the ALJ level.  However, the Department of Health and Human Services (HHS) Office of Hearings and Appeals (OMHA) has been unable to keep up with the number of appeals submitted to them which has lead to a huge ...
Claim denials cost the medical industry over $1 million, annually. How much of that comes from your practice? You spend time interpreting sometimes confusing health plan benefits and coverages and wordy coding guidelines. You go through time-consuming prior authorization processes. And you sign up for a payer’s electronic funds transfer and post claims per their ...
In Billing
Nov 2nd, 2017
If you are as enthusiastic about medical billing and reimbursement, it can be vexing when we receive a denial. Here are some tried and true points that every biller should know to address a true appeal correctly. Know Your Coding In today’s multitasking office you will often find billers who are certified in both collections ...
In Audit
Oct 16th, 2017
You billed the insurance company for a service provided by your office only to receive a denial remittance. Is the denial valid? Why wasn’t the claim paid? Who can review the explanation of benefits summary and make a determination? Enter the appeals analyst — an essential position for physician offices, hospitals and clinics, as well ...