Resources to Decrease Denied Medical Claims.
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Articles & Case Studies

  Displaying Matches 1 thru 16 of 123 Found.  NEXT
Increase Pay-up by Successfully Appealing Claim Denials
Increase Pay-up by Successfully Appealing Claim DenialsLearn why perseverance is the key to a high rate of overturned medical health insurance appeals. . . .more >>
U.S. District Court of Appeals Finds BCBS Direct Payment to Patients Violates Assignment of Benefits Law
The Blue Cross Blue Shield practice of mailing direct payment of out of network benefits to patients instead of assignment-holding providers was recently found to be a violation of Louisiana law, a ruling which casts into question. . . .more >>
Obtaining Correct Benefit Information Prior to Treatment
Most healthcare organizations supplement online eligibility information by verifying benefits over the phone. Unfortunately, carriers routinely warn that benefit information obtained over the phone is. . . .more >>
Bundling Denials Should Have Basis - Requesting Clarification
Bundling denials are highly problematic because various payors use different claim editing software to assess codes for compatibility. It becomes hard to determine why certain codes were bundled and what medical information might be persuasive in an appeal. . . .more >>
Asking Insurers to Deviate from Medical Necessity Clinical Guidelines
Insurance carriers routinely cite evidence-based clinical guidelines when denying treatment authorization. However, a number of insurance industry resources confirm that insurance medical decision makers must consider the patientís unique medical condition and. . . .more >>
Appealing Coordination of Benefits Stalls And Denials
Multiple coverage is typically a favorable situation. However, insurers may delay payments due to coordination of benefits investigations. Further, denials and refund requests related to COB appear to be growing. COB investigation stalling on the part. . . .more >>
Crime Victims Compensation Fund Offers Assistance to Victims of Crimes For Medical Treatment
Use of the crime victims funds is often overlooked or not even offered to victims. Most victims aren't aware such a fund even exists. Seeking some monetary restitution can not reverse the criminal act itself, but it can offer victims and their families financial relief. . . .more >>
Appealing Denied Claims Enhances Customer Service
An aggressive appeals program in your office can be a tremendous boon to your practice's reputation for extending exemplary customer service. . . .more >>
Denial Analysis Tactics to Improve Reimbursement
What gets studied gets improved. This is one of the simplest management concepts yet one of the most challenging when it comes to ambiguous data. What is understood gets improved is the more accurate maxim for analyzing the ambiguous. . . .more >>
Insurance Recovery Requires Attitude
In appealing denied insurance claims, you need to have the mindset that it is the insurance carrier's burden to prove that the claim has been processed correctly and that any ambiguities in the coverage terms. . . .more >>
Assisting Your Out Of Network Patients with Network Inadequacy Appeals
Network adequacy/access to specialist standards are designed to make sure that health plans have an adequate network of providers within a specific geographic area and sufficient specialty care providers to provide quality care. These regulations often. . . .more >>
Less Than The Law Allows
State and Federal Law Require Processing of Explanation of Benefits (EOB's) to Provide Specific Information. . . .more >>
Are You Leaving Money On The Table?
Many practice administrators liken not appealing usual and customary denials to leaving money on the table. However, appealing denied benefits requires providers to justify charges - a task many have found problematic. . . .more >>
Demanding Fee Schedule Disclosure
Demanding Fee Schedule DisclosureWhen a claim appears to be underpaid, your appeal may need to seek disclosure of how the payment was calculated. . . .more >>
Careful Assessment of Injury Claims Could Yield Higher Payoff
Emergency care presents a unique and often discussed problem to business office managers: Treatment must be rendered before ability to pay is assessed.†. . .more >>
Drafting A Level I Appeal: Three Components of a Winning Appeal
Level I appeals need to be submitted timely. Medicare appeals must be filed within 120 days of the claim decision. Most commercial insurers require appeals within 180 days from the denial. These time constraints force medical providers into situations where . . . .more >>

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