Pearls for Denials Management and Appeals

Denials management and appeals are two of the most underestimated processes in rheumatology offices. Most practices lose thousands of dollars each year because of not following up on or incorrectly writing off denied claims. It is crucial for physicians and their staff members to stay on top of denials to boost the revenue cycle.

Here are some key pointers on avoiding denials and what to look for when you receive denials for your claims:

1. Verify that the patient’s name is spelled exactly as it is on his or her insurance card.
2. Confirm that the patient’s identification number is correct (this is the number-one denial for Medicare). Remember, insurance companies and Medicare will not correct the number for you.
3. Ensure that your claims are re-filed in a timely manner.
4. Resolve all denial codes before resubmitting a claim.
5. Verify that a patient’s coverage is effective for the date of service.
6. Know your private carriers’ contracts and your Medicare carrier’s local coverage determinations.
7. Arrange for your coding and billing staff to have up-to-date resource materials (e.g., CPT and ICD-9 coding manuals).

If you find that your denials management and appeals are still not being reimbursed correctly by the insurance companies or Medicare, call the ACR’s coding and reimbursement department at (404) 633-3777 or visit us at www.rheumatology.org, under Practice Support.