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  • Writer's pictureMuhammad Sair Khan


Denied claims are a frequent problem for physician offices and health care facilities across the country. Even when you are in-network, denied claims can stack up, preventing you from collecting revenue you’ve earned.

A recent Kaiser Family Foundation survey found that 19 percent of all in-network claims with Healthcare Marketplace plans were denied in 2017. Shockingly, of those denied claims, only .5 percent were ever appealed. Almost 43 million claims were never appealed, representing millions of dollars of lost revenue or unexpected costs for patients.

Whether you work with a third-party billing team or have in-office billing staff, following up on denied claims is vital for your revenue cycle and your bottom line. While some claims can be time consuming to follow up on, others could be easily appealed with a simple well-written letter.

Create a Plan for Denied Claims

Your billing team should be prepared to follow up on denied claims. Whether each team member is responsible for their own denied claims or you appoint one team member to have this important job, you need a system for managing all unpaid claims.

Your system should include:

  • Follow-up processes, such as checking denial codes

  • A timeline for following up with reminders and alerts to keep you on track

  • A checklist of information that should be checked or gathered up for the appeals process

Understand Appeals Letters

Appeals letters are the key to overturning denied claims. You may be able to speed up the appeal process by having template letters for each denial code ready to go. Then, each time you need to appeal, you can simply fill in the relevant patient and claim information.

For your appeals letter, you’ll need information such as:

  • Prior authorization number (if applicable)

  • Any notes from discussions with insurance representatives

  • Patient name

  • Policy identification number

  • Claim number

  • Your facility name and NPI or tax number

  • Relevant clinical notes that help prove medical necessity

Including all of this information in your letter will improve your chances of overturning the claim denial.

Find the Denial Pattern

There is often a pattern in claim denials. Keep track of your denied claims so you can spot and correct any patterns. Certain policy numbers may require different codes. Code can also vary by payor. By recognizing patterns, you can take steps to correct the issue and prevent future claims from being denied.

Find a Billing Partner You Trust

If you have hired a third-party billing company but they aren’t following up on claims denials -- you are leaving hard earned money on the table.

Don’t miss out on revenue you’ve earned. Contact Datapro today.

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