How good are you in handling claim denials?

BEST-IN-PRACTICE DEALING DENIALS EFFECTIVELY Denial Handling Strategies The 4 type of claim denials & strategies to handle Check the below listed denials and how your office can deal with these effectively using the best-in-practice strategies! : : 8 : 8: : :: : : : : : : : ::: : : : Denial for Timely Filing Wrong #ID Claims denied for timely filing if not filed within the timely filing period. Claim denied for incorrect #ID Often claims are initially submitted with incorrect information. It may be a typo on the part of the biller. It may be that the patient offered the wrong insurance card at the medical office, or Wrong Name Patient's name was misspelled It may be that when the information was transferred from the person who took the info to the person who is doing the billing it wasn't copied correctly It doesn't mean you won't get paid for the services děnied for timely filing- you do need to knów how to handle them Wrong Carrier Lorem ipsum dolor sit amet, consectetur adipiscing elit. Re-Submitted with correct info but carrier denies for timely filing The denial must be appealed SPECIAL FORM GENERIC FORM Check off timely filing' or write in 'denied for timely filing' in the reason for appeål on special forms Attach a copy of the claim, and your proof that you had filed it timely to that form Proof for original submission Claim filed Electronically have an electronic report showing the original submission Paper Claim PMS provides reports showing original submission date & if muitiple submission Not in Time For patients covered after If you have a valid reason, 28 filing deadline Appeal explaining what happened be overturned and allowed 8 Valid reason your appeal will most likely Denial for duplicate service Reasons No record of payment EOB EOB not passed to billing service when claim processed 1st Reason1 圖 ) Duplicate date of service CLAIMS Claims were submitted on two separate billings Reason2 THE PAYER Insurance carrier made an error Claim hits up against another claim for a different provider and a different service on the same date Reason3 How do you handle each of these possibilities? If you don't find that claim was previously paid If paid previously, make sure the check was received and cashed by provider If submitted the claim on two separate billings & if it's very frequent, Make sure the claim isn't entered twice. You want to check any billings where multiple dates of service were sent in that time frame. Check with the insurance carrier and find out what happened the first time the claim was processed. When was it processed and what was the outcome? You need to be more Explain the provider importance of getting a copy of the EOBS. It is a great waste of time to be tracking processed claims and a trigger for fraud with the insurance carriers. careful and check when entering new claims to see if these claims have already been submitted & fínd a system to prevent this duplicate billing A Multiple Date of Service Check with the (?) Payer Importance of EOB Duplicate Billing : : : : : : :: : :: : : : :: :: : : : : :: : :: 8: : : :: 8: 8 :: :: : 8: Denials For No Coverage/Coverage Terminated The local BCBS denies claims for this reason more often.It issued the patient a new ID number or changed just the 3 letter prefix. Córrect ID can be found in most cases in BCBS web if you do a search on patient Check patient's claim history. Has the payer been making payments but suddenly stopped? In some cases the payer may have paid claims béfore and after the date of service they are denying. Call the insurance carrier to question the denial, If no info on WEB call the patient. Send out a patient statement with the charges, and a note stating "Your insurance carrier states your coverage was terminated. Please contact our office with updated insurance information. New Patient ID Patient's Claim History Patient Statement Out of Network Claims Reasons A Not a valid bill code CODE Payer just requires a different type of bill Reason1 Patient gets the payment PATIENT Claims are paid directly to the patient Reason2 Followup on claims FOLLWUP Not an easy task but if you just stay on top of it, it can be done. Reason3 CONTACTUS: , BillingParadise [email protected] 24 Revenue Cycle Masters d de d 0 : : : :: : : : :: :: :: : : :: ::: : :: :: : H:: : :: :: :: :: : :: : : : :::::: :: :: :: : :: : : : : :: : : : : : :: : :: :: :* : :: :::::: :*: :::::::::::::::::: :: :: : ::: : : :::: ::****:*:: ::: :::::::: :: :::: ::: 3 : :: :: * : : *::: : : :**:: : ***** : *** : : : :: : : : : : :: : : : : : : : : *:*: : : : : : : : : *::*:: :: :: :