Denial claim handling problems and how to solve it

General Problems

• Not appealing denied claims
• Appealing denied claims without making any changes in the claim
• Poor documentation
• Using improper terminology
• Not getting all charges billed

Not Appealing Denied Claims

• All denied claims should be reviewed by the physician and the billing specialist for correctable errors
• Correct the errors and resubmit the claim as a corrected claim

Appealing Denied Claims

Without Making Any Changes

• The definition of insanity is doing the same thing over and over with out changes and expecting different results
• Correct the errors and resubmit as a corrected claim

Poor Documentation

• The documentation should support the level of service coded
• Document what you do and code to the documentation
• Separate the E/M service from the radiology and procedures in the note

Not Getting All Charges Billed

• Audit the transfer of information from “routing slip” to billing program
• Make sure all charges get appropriately billed

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