Let’s chat about denials. As I’m sure you know, claim denials can cause huge problems for your practice. Filing the claim is the easy part, the tricky part is working the denials that come in. Through absolutely no fault of your own, denials–both legitimate and in error–are going to happen. They range from an easy fix, such as wrong DOB for patient, to a procedure that’s not medically necessary, and then many times the denials are in error. I recently saw one insurance company deny anesthesia claims for coronary artery bypass graft because of medical necessity. Obviously that claims processor has never had open heart surgery! The point is this totally necessary claim will cost man-hours to get it paid, when it should have been paid automatically. Regardless, you must work these denials, or I can guarantee that your practice will suffer.

When we are called in to help a practice, one of the most common problems we see is that the denials are not being worked. And, keep in mind, most payors have a timely filing limit for denials. It’s not fun, and while it’s time consuming, it’s also necessary. Nothing should be billed that you don’t expect to be paid. Therefore, no line item should adjusted off without good cause, and the payor’s “DENIED” is not a valid reason.

–Pam Stopher, CPC, ACS-AN
Park Medical Management, Inc.