Denials and appeals

Follow in the footsteps of leading organizations and get the most out of your denial programs with these four steps.

Q: How can coding and patient financial services staff work together to create an effective claims edit team?

By Alicia Kutzer, Esq., LLM, MHA

It is critical for providers and any person who is involved with healthcare revenue integrity to stay as current as possible or risk losing out on opportunities to ensure proper and full payment of millions of dollars’ worth of billed and/or billable claims, and the National Association of Healthcare Revenue Integrity’s 2018 Revenue Integrity Symposium can help professionals do just that.

Q: Are there any best practices for managing additional documentation requests (ADR)?

Q: What is a denial avoidance program and how does it differ from a denials management program?

What strategies should hospitals follow for deciding whether to appeal denied claims and submitting appeal letters?

Many HIM directors find that managing the coding team requires a different type of focus than other functions within the department. This may be true because coding professionals have advanced education, prefer a quiet work environment, and require less direction.

What is a good strategy for sharing denials data with the medical staff to ensure they understand weaknesses?

The Office of Inspector General (OIG) plans to address concerns regarding capitated payment models by putting preauthorization denials under review.

When evaluating a code edit, it’s necessary to understand exactly when or where in the claim or billing process the edit arose. Look to coding guidance to help edit resolution efforts.