Have a plan for identifying and appealing denied charges in your physician practice

In my last blog post, I talked about actions that could result in denied claims by third party payers. It is very important you have a system in place to review why certain claims are getting denied. In many PM systems, you can set up denial codes - when an EOB shows a denial, the poster/reviewer logs the reason for the denial in the system. This way you can simply print a report weekly to see why claims are being denied. If your system does not support this set up, then you are going to have to have a manual system whereby EOBs showing a denied charge are copied and placed in a central location for review.

It doesn't take a rocket scientist to figure out how important it is to review why charges are getting denied and fixing the problem(s) sooner than later.

However, did you know the MGMA says that only 35 percent of providers appeal denied claims? Why are the other 65% leaving money on the table? Your billing staff must start the appeal process as soon as you receive a denial. To better prepare your practice to handle denials, try the following:

-Create a list of payers’ appeal deadlines. Each payer may have a different timeframe for denial appeals, ranging from 45 days to a year. From there, organize denials by deadline.

-Develop an appeal letter template for the most common denial reasons. Where possible, use the specific wording from the payer’s written and electronic publications.

-Consider appeals software tools. This software allows you to streamline denials and appeals, track the progress of a denial and create reports for denial prevention. Look for software that is compatible with your current practice management system.