Claim related issues including audits, denials and appeals take center stage to us because they are so important to providers.
Denials and appeals lead to financial variances and yet so many of them can easily be avoided. In 2012 35-47% of a physician’s office revenue dollars was lost to appeal or denied claims.
Claims can be denied for numerous reasons and it is our responsibility to take on these denials. We audit and appeal within a timely period so if reprocessing is allowed by the insurance company, we can still collect on the allowed reimbursement. Top 5 denial errors are:
- Lack of information
- No coverage for billing services
- Timely filing
- Duplicate claims
- Eligibility terminations