Medical Billing: Follow These 6 Steps To Keep Your Appeals Afloat

By Author: Benito Dalton
Total Articles: 2
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Denial is one word that most coders would not want to hear, and would also rather want to erase from their dictionary. But however hard we all may try, there are times when as coders we are faced with denials. Medical billing CPT codes can be tricky, but you can ease the pain of denials if you face them by appealing the right way.

While an explanation of benefits (EOB) can elicit a collective sigh from medical billing offices, but EOBs can also be your best friend when you are seeking increased reimbursement. Bring these tips to use to efficiently process denials, and watch your bottom line soar.

1. It is all about your attitude. You don't have to accept defeat when you get just any dollar amount on the remit. If you are quick to file away EOBs that offer partial reimbursement, track, for just one month, the difference between amount you billed and the amount that got approved. You will now see the amount of money you are leaving on the table.

2. Keep a watch on time. Billing experts say that the sooner you address denials, the better are your chances of overturning them.

3. Be aware of common ...
... errors in your claims form. If you notice, there may be a simple reason for a pattern of denials. Just double-checking your physician’s and patient information can help you get the reimbursement your practice deserves. Make sure that you mention the correct UPIN of the referring physician for services that require that information. Also remember to update and properly record the patients’ ID numbers. It is also a good idea to keep on top of any regulation or policy changes with your Medicare or other private insurance carriers to avoid chronic denials.

4. Reimbursement is just a phone call away. One of the most frequent and common error that most coders do is forgetting to append modifiers to the CPT® codes, say billing experts. You can use a phone call to check with the Medicare or insurance providers to complete the appeal process. A simple modifier correction is all that may be needed.

5. Organize and analyze. In order to stay up to speed on your most common and frequent denial sources, try seeking help from your systems vendors. They may be able to help you codify the message fields on your explanation of benefits to generate reports for current action items and future research data. You can use this information to find patterns in denial causes, know your payers’ preferences, and learn about often-disputed procedures to gain greater returns on future claims. Billing experts say that you should follow up with such reports at least once every three months.

6. Lay all your cards on the table. When you deal with more complex appeals, additional documentation is the key to overturning the denial. You should consider seeking clarification from your physician if there is a need. In fact submitting a cover letter explaining why a certain procedure was performed and why the procedure deserves extra reimbursement can be helpful in convincing the insurance payers.