Tuesday, August 4, 2015

What are RCM Best Practices for Denial Handling?

With more patients relying on the government to supplement their healthcare needs, every medical facility’s viability depends largely on effective revenue cycle management (RCM). One of the most important phases of RCM is denials resolution; a facility can lose thousands of dollars each year if they don’t appeal denials. This article will serve as a brief guide for billing officers:
  1. Check for form-filling mistakes. Has the patient filled out the forms correctly? Are they truly eligible for SSA benefits? Often, a lot of time is wasted because the patient was ineligible in the first place. Conversely, the government agency may have committed some errors that resulted in the claim’s denial. If unsure, forward the files to an eligibility expert to determine the area of lapses. 
  2. Inform the patient. If the denial seems valid, or if you cannot find other information needed to refute the denial, contact the patient directly. Send them a copy of the notification along with your billing statement to remind them to call you promptly and update you of any information changes pertinent to the appeal. 
  3. Ensure timely filing. Regardless of how solid your appeal argument may be, it can be denied outright when submitted late, so ensure you file it on time. Generate an electronic summary report of submitted claims, denied claims, and appeals indicating date, details, and the steps you will be taking to correct them. If you don’t know how to write appeals, seek the help of an RCM expert.

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