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Outpatient Surgery E-Weekly

Contact Congress Over Drug Shortage Issues

A Kentucky congressman is urging surgical facilities to contact their members of Congress and request that they sign his letter demanding changes to...

N.J. Posts ASC Inspection Reports Online

State and federal inspection reports of New Jersey's ASCs are now available online, giving patients an opportunity to make more informed choices abo...

Are Opioids Necessary?

While it's not always practical, or even possible, to eliminate opioids from your post-op pain management regiment, reducing their use in favor of n...

Archive > January, 2008 Vol. IX, No. 1

Get Out of Denial

How to appeal returned and underpaid claims - and win.

Denied claims cost healthcare organizations 1 to 3 percent of their total revenue, according to the Advisory Board Co., a healthcare management firm based in Washington, D.C. Put another way: Payors deny about 1 in every 7 claims you submit. A denied claim sitting on your coder's desk is uncollected revenue and a harbinger of the expense of dealing with the denial in order to recoup the money owed to your facility. We talked to experts and came with these 13 denial management tips.

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1. Act quickly; 2. Follow protocol; 3. Keep ‘em clean; 4. Pay the payors a visit; 5. Speak to God, not his saints; 6. Write a letter; 7. Hold your ground; 8. Map it out; 9. Get the patient involved; 10. Make a formal appeal; 11. Take it to the top; 12. Stay tough; 13. Get over it; Deal with it; Act; America's Health Insurance Plans; America's Health Insurance Plans Center; Banks; Biller; Billing; CPT; Care Biller; Center; Center Billing; Claims Duplicate; Create; D.C. Put; Deal; Denied; Denied Claims Duplicate; Department; Depending; Follow; Forum Health; HMOs; Health; Health Care Biller... show all keywords
1. Act quickly; 2. Follow protocol; 3. Keep ‘em clean; 4. Pay the payors a visit; 5. Speak to God, not his saints; 6. Write a letter; 7. Hold your ground; 8. Map it out; 9. Get the patient involved; 10. Make a formal appeal; 11. Take it to the top; 12. Stay tough; 13. Get over it; Deal with it; Act; America's Health Insurance Plans; America's Health Insurance Plans Center; Banks; Biller; Billing; CPT; Care Biller; Center; Center Billing; Claims Duplicate; Create; D.C. Put; Deal; Denied; Denied Claims Duplicate; Department; Depending; Follow; Forum Health; HMOs; Health; Health Care Biller; Health Insurance Plans; Health Insurance Plans Center; Health System; High Point Regional Health System; High Point, N.C. If; Hold; Hospitals; Include; Incorporate; Insurance Plans; Insurance Plans Center; Make; Map; Medicare; Medicare. She's; Ms. Banks; N.C. If; National Surgical Hospitals; Part; Pay; Payors; Plans; Plans Center; Point Regional Health System; Point, N.C. If; Policy; Put; Reasons; Record; Regent Surgical Health; Regional Health System; Serbin Surgery Center Billing; She's; Speak; Stay; Surgery Center Billing; Surgical Health; Surgical Hospitals; System; Washington, D.C. Put; Web; Write; York Department; York HMOs; address; addressing; administrative; admit; ahead; appeal; appealing; appeals; area; argue; asks; attention; authorization; back; backlog; bargain; based; benefits; blue; bouncing; bring; business; case; center; certified; chain; chance; check; claim; claims; clinical; clock; code; coder's; codes; companies; company; condition; consistent; consultant; contracts; conversations; coordination; cost; cover; coverage; create; cycle; daily; data; date; days; deal; dealing; dealt; decent; decrease; denial; denials; denied; deny; department; describe; desk; deviation; devote; director; doctor's; documentation; dollar; download; editor; effect; employees; end; error; evidence-based; expense; experts; explanation; extra; fact; feel; fight; fills; firm; fix; fixing; foggier; form; formal; format; forms; found; frustrating; full-time; gave; goal; guard; guidelines; harbinger; health; healthcare; heavy; high-dollar; hospitals; important; include; including; incorrect; ineligible; information; initially; insurance; key; law; lead; learn; letter; letters; level; levels; life; lifting; lost; luck; mail; mailing; make; management; manager; manages; manual; matter; medical; member; method; minor; mistake; money; multi-surgery; number; office; one-third; operates; operations; order; organizations; outline; owed; part; patient; paying; payment; payor; payors; pending; percent; person; personal; phone; photocopies; pre-existing; president; prevent; pricing; primary; private; processes; processing; proof; proper; provide; provider; providers; quick; quickly; quirks; re-submit; reason; receipt; receive; record; recoup; referrals; reflects; related; relations; relationship; relevant; reports; require; reset; respond; responsibility; resubmission; return; revenue; reversed; review; reviewed; rights; save; send; senior; showing; similar; sitting; solid; speak; study; submission; submit; submitted; subsequent; success; supervisors; supplying; surgery; system; systematic; taking; talked; tedious; third-party; time; timeline; timely; total; track; train; treated; trends; true; type; uncollected; underpaid; verify; vice; visit; visiting; weak; weekly; weeks; win; work; writing; ‘em

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