Medical billing has a lot of complexity to it, with many stakeholders involved throughout the process. Many steps have to be followed to guarantee precise and timely payments. The difference between good and bad medical billing can be the difference between a functional and dysfunctional lab, practice, or hospital. Today, we’ll be going over the process of appealing medical claims and how to make sure your appeals get followed up in a quick and accurate manner. With a solid appeals system, your revenue system will be much stronger.
Medical Billing Appeals Process
The primary responsibility of medical billing specialists is to know the payment responsibilities of the patients, look at their insurance coverage, get proper billing forms made, and collect all of the right payments from either the patients or the insurance plans.
The process of appealing medical claims starts at the time when a patient gets an appointment scheduled, and it comes to an end at the time when the patient or their insurance company has the reimbursement collected from them.
Why Claims Get Denied
The medical billing appeals process gets used whenever either the patient or payer has a disagreement with a service or item that is provided, resulting in the withholding of reimbursement.
Healthcare provider offices have to take time and purchase resources so that they can start appealing medical claims. It stops auditors from looking into tough claims and assists the providers in gathering money.
If providers aren’t identifying and appealing medical claims that have been denied, it could give auditors the impression that the providers aren’t aware of possible compliance issues or improper medical billing.
Steps for Appealing Medical Claims
It helps if you contact the insurance company because many denied claims have fairly generic denial codes, and these codes don’t go over the exact reason that reimbursement was withheld. When you make a call to an insurance company, you should make note of the name of the representative who spoke with you, when the call was made, and the reference number for your call.
When a claim is corrected, use the claim number that is on that newly corrected claim. If you don’t, your claim will error out, being considered a duplicate. It will also help you to determine precisely what needs to be appealed. Appealing every denial can be tough, so sometimes prioritizing some over others is preferred, such as prioritizing the high dollar claims.
Categorizing denials is a great way to figure out patterns and see common trends for why medical claims are denied. It also assists you in the streamlining of your appeals process.
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