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Tips on how to appeal on denied claims

Dec 18, 2019
prominence-of-provider-credentialing

Getting reimbursed for services rendered should be the least of worries for a healthcare provider. Unfortunately, claims are denied often and for various reasons. Luckily, providers can get insurance payers to reverse their decisions. Under the affordable care act, providers have the right to appeal denied and get 6 months to appeal any denials. Insurance companies too are required to declare the reasons for denied claims. Denial management is important for effective revenue cycle management. Working with a good billing company can make the process even faster and make managing appeals on denied claims easier. As a healthcare service provider, If you have been wondering about reasons for repeated claim denials, probably this is what you need to catch up on. By following these tips, providers can ensure that chances of a successful appeal are maximized. Understanding the reason for denial The very first step in filing an appeal to […]

The three enrollment E’s | EDI, ERA & EFT

Dec 18, 2019
BCBS-insurance-credentialing-services

A large number of cases related to a delay in reimbursement, and claim denials owe to incorrect enrollment. When we on-board your practice, we make sure your three E’s are set up just right. EDI (ELECTRONIC DATA INTERCHANGE) EDI (Electronic Data Interchange) makes the journey of your medical claim to the payer’s system seamless. There is a need for this system to be set up accurately for every single-payer that you are contracted with. This ensures that your claim hits the payer system in the first go and reimbursements are not delayed. That’s what our enrollment department excels at! We ensure that the entire payer mix is studied closely, and EDI enrollment is worked on a priority basis to ensure a seamless flow of revenue.   ERA (ELECTRONIC REMITTANCE ADVICE) If ERAs (Electronic Remittance Advice) of your medical practice are not set up correctly, you won’t be able to receive payments […]

3 ways to prevent denied claims

Dec 18, 2019
letter-of-interest

For healthcare facilities, denied claims are a constant threat to the businesses’ bottom line. This is especially true for practices that rely on a constant inflow of revenue from claim reimbursements. An increase in the number of denials burden the revenue cycle, the negative effects further compounded by additional workload and inability to generate more revenue. It is a vicious cycle! Healthcare management professions estimate that out of $3 Trillion in medical claims submitted last year, approximately $262 billion worth of claims were denied. Healthcare facilities nationwide leave behind a lot of money on the table but it doesn’t have to be that way. A careful approach to claims processing combined with consistent follow-up can eliminate a majority of denied claims. If a medical facility or hospital wishes to accelerate their cash flow and bring the administrative cost down, they need to work on reducing the amount of denied claims. […]

Some basics of laboratory billing for you to know

Dec 14, 2019
Lab Medical Billing

The field of laboratory medical billing is unlike physicians, hospitals, or DME billing specialties. It is centered on a very specific set of CPT codes. The codes used by a lab includes services that are used to evaluate specimens obtained from a patient sample. It won’t be wrong to say that labs run labs. And, that’s what they bill for. Laboratories carry out testing procedures for samples provided by a doctor who orders them. Once it is done, results are handed over to the doctor, who then uses these results to suggest and finalize treatment procedures for his patients. Lab samples are required to be prepared and screened by qualified laboratory personnel with the help of a pathologist who assumes the risk of interpretation. This means that a majority of professionals working in a lab and running the tests are lab technicians. In a normal lab set-up, tests are conducted […]