Vision Infonet Inc
info@pes-in.com
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services coding and billing
 

Experienced & Affordable

Incredible team of professionals

Certified Billing and Coding team
Dedicated Account Manager
HIPAA compliance
Free trial with no obligation

No Set-up or Start-up fee

Excellent Client Support

Faster reimbursement

Increased cash flow

Intensive A/R follow-up

Pay us only after you get paid

Free PM software and EMR

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  Advantages | | Medical Billing | Revenue Recovery | Billing Cycle |  FAQs  


General Reasons for claim denial are as follows:
 
Under coding or Up coding medical claims.
Improper usage/non-usage of Modifiers.
Not meeting medical necessity.
ABN Policies.
Payer agreements.
Improper demographics.
Improper verification of eligibility and benefits etc.
 
Following diagram shows the general reasons for denials with approximate percentage of each reason.
 
 
Our staff has a good understanding of the above, contracts between payers and providers.
We interpret, analyze and identify systemic underpayments by payers at the individual claim level.
We do consistent, personalized, courteous follow-up on all accounts with outstanding balances.
We do have excellent AR follow-up skills to call upon payers, enquire about the correct reason for denial and work as per their clarification and getting the claim paid.
This entire process involves following up on underpaid claims, understanding the reasons for underpayment, and then recovering revenues from the payers by taking steps to address those issues (resubmitting claims, appeals, etc.)
 
When Claim needs Medical Necessity notes, Pre Existing information, Place of service or type of service etc., these notes will be collected from the client’s end, analysed and submitted to the payers.
 
Appeals:
 
We have a system to time appeals submitted and ensure that no time is wasted in the appeal process. We also develop standard appeal letters that can be easily customized with information about the particular patient and situation involved in every denial.
If an insurer routinely down-codes claims, we appeal for the code that was submitted originally and include supporting documentation.
If an insurer consistently refuses payment for a certain code, we request the physicians to contact the insurer, discuss the situation and bring along supporting documentation instead of sending more appeals.
Before signing any contract with a payer, we request the physicians to make sure that the claim appeal process is explained clearly. This helps us determine steps to be taken after a denial and consider steps for further action.
 
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