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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 > February, 2009 Vol. X, No. 2

Maximize Your Insurance Reimbursement

Nine tips to avoid denials and collect all that's owed to you.

Karlene Dittrich, CBCS

If getting reimbursed is a game, then you're playing at a distinct disadvantage. Managed care contracts are written using payors' terms and conditions. When payors deny or delay your claims, you appeal once, maybe twice, but in the end you know you're not going to get paid fully or fairly. Read on for advice on beating insurers at their own game.

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1. Study the clinical rationale.; 2. Gather pertinent patient information.; 3. Beef up your assignment of benefits.; 4. Handling HIPAA barriers.; 5. Head off pre-existing conditions.; 6. Follow the claims trail.; 7. Denial, your mistake or theirs?; 8. Challenge lost records.; 9. When you hit a wall, appeal.; Staying a step ahead; Beef; Binding Assignment; CFR; Challenge; Compare; Confirm; Demand; Excel; Focus; Follow; Gather; HIPAA; HIPAA-protected; Handling HIPAA; Head; Insurance; Managed; Non-reimbursement; Outsource; Payors; Qualifications; Read; Request; Review; Send; Stamp; State; Study; ... show all keywords
1. Study the clinical rationale.; 2. Gather pertinent patient information.; 3. Beef up your assignment of benefits.; 4. Handling HIPAA barriers.; 5. Head off pre-existing conditions.; 6. Follow the claims trail.; 7. Denial, your mistake or theirs?; 8. Challenge lost records.; 9. When you hit a wall, appeal.; Staying a step ahead; Beef; Binding Assignment; CFR; Challenge; Compare; Confirm; Demand; Excel; Focus; Follow; Gather; HIPAA; HIPAA-protected; Handling HIPAA; Head; Insurance; Managed; Non-reimbursement; Outsource; Payors; Qualifications; Read; Request; Review; Send; Stamp; State; Study; Web; accept; acknowledge; add; additional; address; adjuster's; administered; administrative; advice; alleviates; ambiguity; and/or; appeal; appeals; applicable; appointed; areas; assign; assignment; associates; attempts; audit; authorization; authorize; automobile; beat; beating; begin; benefit; breakdown; bundling; business; call; care; carefully; case; cashed; cashes; certified; check; child; cites; citing; claim; clinical; clinically; coding; collection; common; communication; companies; company's; compensation; compliance; concern; condition; contact; contracts; copy; cost-containment; coverage; covered; create; creative; credible; criteria; current; data; date; days; delay; denial; denials; denied; denies; deny; department; designate; determine; direct; directing; directly; disclosure; distinct; documentation; documented; documents; due; effective; effectively; employee; employer; employment; end; ensure; entity; entry; equipped; errors; excluding; expand; extension; external; facility; failed; failure; federal; feel; files; financial; find; follow; formal; frame; frustration; fully; gallbladder; game; gaps; give; group; guarantee; guidelines; hands-down; health; healthcare; high-cost; hit; holding; hunt; in-network; inaccurate; inappropriate; incentive; include; including; incomplete; incorrect; information; injury; insurance; insurer; insurers; intention; interest; internal; involved; involves; involving; justify; learn; letter; level; limitations; listed; litigation; long-term; loopholes; lost; made; mail; mailed; make; making; medical; meet; meeting; meets; misplaced; mistake; month; national; nausea; necessity; out-of-network; page; paid; paper; past; patient; patients; paying; payment; payor; payors; penalties; performs; periods; permissible; person; pertinent; physicians; plan; playing; policies; policy; position; potential; pre-certification; pre-existing; prevent; prevention; previous; previously; primarily; primary; prior; privacy; private; problem; procedure; processed; promised; proof; protected; protecting; provider; providing; punish; purpose; qualifies; quality; rationale; reasons; receipt; received; recognize; reconsiderations; records; recover; recovering; recovery; recurring; regulation; regulatory; reimbursed; related; relating; rely; reply; representative; reps; request; requesting; requests; requiring; result; return; revenue; review; reviews; rights; rules; security; send; sending; services; set; sign; simple; site; situation; sole; solutions; specialist; specific; spouse; stall; standards; start; state; step; stonewall; supplying; support; surgeons; symptom; tactic; team; termination; terms; time; tracking; transfer; transposed; treated; treatment; trending; uncomfortable; understand; untimely; unwarranted; update; valid; vary; vomiting; waiting; win; working; worst-case; write; written

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