of eligibility and benefits etc.
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
interpret, analyze and identify systemic underpayments by payers
at the individual claim level.
do consistent, personalized, courteous follow-up on all accounts
with outstanding balances.
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.
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.)
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.
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
an insurer routinely down-codes claims, we appeal for the
code that was submitted originally and include supporting
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.
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.