Steps to Appeal for Denied Claims -Avontix

To ensure that the procedures and tests performed on a patient are coded accurately and billed appropriately is the basic method to avoid and eliminate any claim denials. Irrespective of the precautions taken and measures adopted, there would still be some errors that result in denials. An effective revenue cycle management requires taking effective measures so as to minimize denials and appeal the denials in time, so that they are reversed to bring in revenue to the facility.

Following the below steps will help in better revenue cycle management with regard to denials.

Analyze claims contract: Every insurance provider follows its own procedures and norms. Hence, it is the topmost priority to review and analyze the claims contract so as to check if you are following the correct procedures and adhering to their guidelines.
Prepare a strong appeal letter: A significant task in revenue cycle management process is preparing an appeal letter that is strong and convincing to repeal the denial. Ensure all the correct details of the patient including name, health insurer ID, insurance details, and date of service are mentioned. An important point to be noted is that while challenging the denial your appeal it should be validated with a strong reason.
Use detailed information: You should prepare your appeal with thorough documentation of reasons in support of your argument. For this, comprehensive data has to be gathered from the patient and health records of the patient. Upon doing this, get the appeal letter reviewed and signed by the physician to ensure if all the details are accurate.
Have your contacts: Make sure your appeal letter is received by the intended person. Make contacts and ensure that you get information if your appeal letter is received or not. This may seem very simple but is very critical as there are more chances to miss a denial appeal if there is no person to contact at the other end.
Follow up: One of the most demanding tasks of RCM services is to follow up regularly. Following up with the health insurer regularly enquiring about the appeal status is vital to know the status of the appeal and take other necessary steps.
Be ready: RCM services providers suggest that depending on your previous experiences and denial cases, be ready with the template of an appeal letter that would speed up your appeal procedure. This is a significant part of RCM services.

Appealing is a tedious and time-consuming process that is dreaded by most physicians and healthcare providers. None the less, it plays a critical role in the revenue cycle management that can considerably improve the healthcare provider’s bottom line.

Comments

Rules and Regulations that Govern Healthcare Documentation -Avontix

Picture courtesy: Google Images Healthcare documentation as the name suggests deals with the documentation of healthcare procedures and treatments provided to a patient. As a way to minimize the workload of physicians in documenting their processes in providing healthcare to patients, healthcare documentation plays a critical role in the healthcare industry and gives the physicians much-needed extra time to spend on looking at a more number patients. For the people in healthcare documentation jobs, it is not just sufficient to master the English language skills and medical terminology to be able to do their work efficiently. There are certain points related to the federal rules and regulations that are to be taken care of while transcribing the data accurately within the set time limits. Professional healthcare documentation specialists are expected to be aware of these legal requirements and act accordingly. Confidentiality of patient information: Medical details of a...

Role of Proofreading in Healthcare Documentation -Avontix

Picture courtesy: careeraddict.com M edical transcription or healthcare documentation deals with the documentation of voice files which is prone to many errors due to the kind of work it involves. Healthcare documentation specialists have to listen to various physicians’ voice files with different accents and document them in a prescribed format. Often there are issues with the voice files regarding the background noises, the clarity in the physician’s speech etc. that give a challenge to the medical transcriptionist. Moreover, many people in healthcare documentation jobs work remotely without any immediate supervisor to rectify errors if there are any. This kind of work needs that the medical transcriptionist is independent, self-motivated and responsible towards the work being done. Being an indispensable part of the healthcare industry, the healthcare documentation specialists take pride in their jobs and work relentlessly for the accuracy and comprehensiveness of the docume...

Good Listening Skills Lead to Effective Communication - Avontix

Picture courtesy: toolshero.com T o engage in effective communication, one needs to listen properly and respond. We all know there’s a difference between hearing and listening. When a sound is sensed by the ears, hearing happens; this doesn’t require any special efforts. However, listening happens only when we consciously put efforts to understand the meaning of the words.This requires concentration on what others are saying. Listening by itself requires efforts, so one can understand that listening well requires much more efforts and concentration. To be able to mingle with others easily and actively participate in conversations, it is important that we listen well. Many people wrongly assume that if they are not talking much and letting others do the talking, they are good listeners. What happens in such cases is that they might be hearing to what others say rather than listening well. Listening is an art in itself that needs the practice to perfect. Here are some pointers...

Search This Blog