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How To Manage Denied Claim Appeals to Maximize Your Revenue?

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23 Mar

How To Manage Denied Claim Appeals to Maximize Your Revenue?

How To Manage Denied Claim Appeals to Maximize Your Revenue?

Denied claim appeals refer to the process of challenging a payers decision to deny reimbursement for a healthcare service or treatment.

When the insurance denies a claim, an appeal can be filed to challenge that decision and in some cases insurance can be convinced to overturn their decision. The appeal process involves submitting additional information, documentation, or evidence to support the claim and requesting a reconsideration of the original decision. There are different levels of appeals available with each payer, all with specific requirements and deadlines.

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Want a faster denial and appeals management process? Read below for more tips and details about the way TriumpHealth medical billing services team tackles denials and appeals.

Firstly, TriumpHealth assigns a medical billing specialist to your practice to work on any claim denials from a payer. The assigned specialist follows through with below steps.

Understand the Reasons for Denial

The initial step when initiating an appeal to an insurance company is to comprehend the rationale or reason behind their denial e.g., medical necessity, coding, LCD guidelines etc. Upon receiving the EOB (Explanation of Benefits) including specific denial codes, the decision regarding the claim is documented in its entirety. If the explanation remains unclear, the payer is contacted directly. It is medical providers right to acquire claim denial information, and payers are obligated to explain it in a language that is easily understood.

Eliminating The Easy Issues

Claim denials can stem from numerous factors, with data entry errors being among the most frequent. These can manifest in the form of patient demographic errors including, misspelled names, erroneous insurance policy numbers, mismatched dates of services etc. It is crucial to thoroughly examine the documentation furnished by the insurance company and scrutinize it for any errors. If any discrepancies are identified, TriumpHealth medical billing specialist bring this to the attention of the insurance company representative for rectification. The claim is corrected and resubmitted for payer adjudication.

Collecting The Evidence

Unnecessary denials of claims can also arise due to the provision of services that are not deemed medically necessary. To avoid this, it is imperative to have sufficient proof and documentation supporting the treatment or services being offered, obviating the need to demonstrate their medical necessity later. Referrals and other pertinent information regarding the patient’s medical history can aid in the approval of the claim. If required, it may be advisable to refer to the health plan’s policy or guidelines for the services being billed, which can be accessed online through the payer portals.

Organization is Key

TriumpHealth medical billing services include storage of all medical billing paperwork in a secure and HIPAA compliant portal to ensure organization, transparency, and streamlined process. The billing paperwork is organized and saved in clearly labeled folders with proper file naming nomenclature for easy accessibility and management, including payer, patient name, and date of service.

Submitting The Essential Documents

The necessary appeal letter is composed based on a specific template designed for specific CPT code and payer. The composed appeal letter is either faxed or uploaded to the payer portal and includes the claim number and other pertinent patient details. Typically, payers handle claims submitted via their standard appeals form or portal more expeditiously. The EOB from the insurance company may also provide information about the appeal process.

Are you seeking one of the best medical billing companies in Texas? If yes, then you can reach out to TriumpHealth at 888-747-3836 x0 today and speak with a medical billing expert. Our trustworthy solutions make your denial and appeals management process easier and efficient!