Failure to Address Denials or Incorrect Reimbursement From Third-Party Payors
ASC Revenue Leak Tip
Policies and procedures should be instituted to effectively address denials and initiate appeals. Follow these steps:
1. Determine denial trends by creating a log to track the cause(s) of claim denials:
No coverage at DOS
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2. Understand each payor’s appeal process.
3. Create an effective appeals process that addresses all types of denials.
4. Initiate appeal promptly for non-payment or erroneous payment of claim. Try to resolve through online or telephone inquiries. If these attempts fail, file an immediate appeal by:
verifying proper address for appeals;
writing appeal letters and include information needed to support claims;
taking appeals to highest level;
requesting interest where applicable; and
documenting all processes used with dates.
5. Review the final log at the end of the month. Ask payment poster to review the previous month’s log and prepare a report on the dispensation of the denials. If claims are in the appeals process, request update when the appeal is completed.
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