Denials

Here’s how to use these code add-ons correctly to help you get paid what you deserve

One of the thorniest coding questions is: Can a physician bill for family meetings when the patient is not present? If so, who gets the bill ?

Advance preparation is your key to successfully managing the ICD-10 conversion. Here’s what your practice needs to know and do to get ready.

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Medicare denies claims for 26 percent of all services submitted. More distressing -- 40 percent of those services are never resubmitted for payment by providers. Talk about missed opportunities! Customize this form letter -- and the ones below -- to appeal claims denied, no matter who the payer is. Use this letter to show payers that the claims you are sending are not dups, but corrections.

Compare your denial rate from Medicare to national averages for your specialty by total amount denied, number of services denied, or percent of services denied. Data from the Centers for Medicare and Medicaid Services.

Manage your denials from insurance companies by tracking them in this worksheet. Track the denials according to the functional area to identify opportunities for improvement. By tracking and monitoring denials, you can fix the problem and prevent denials in the first place.

Specialists, use this waiver if a patient forgot his referral. It says that the patient agrees to pay for services rendered that are not covered by his managed care company.

Our fifth edition of PayerView uses real claims data to examine and rank payers based on financial and administrative performance, as well as efficiency. Here’s to friendly competition that helps docs get paid.

What is the simplest method for reducing denials? Get the correct patient data from the start.

Medicare is getting more aggressive with audits through its Recovery Audit Contractor program. Here’s how to assess your billing procedures to avoid audits, and establish a process for when a RAC does come knocking.

Billing massage chair use; using the AI modifier; getting paid for pulse ox.

Here's a primer to assist your medical practice maintain its patient records and avoid any legal troubles.

Jason A. Borton, MD, on the parallels between growing giant pumpkins and life in the emergency department.

Knowledge is power in the payer game. Expert Lucien Roberts explains how to evaluate your payers and then use that information to negotiate better reimbursements.

Concerned about Medicare’s new Recovery Audit Contractors snooping around? Though your practice may not be affected by RACs for at least a year, the time to ready your defenses is now. Here’s how.

Consultant Susanne Madden offers a step-by-step guide to handling payer take-backs and not getting bullied into writing a check without researching the situation.

Do you feel helpless against the threat of lawsuits? Many docs do. Yet there are ways to reduce your risk of being sued. Arm yourself with best practices, to keep malpractice lawyers at bay.

Recovery Audit Contractor (RAC) is a term that every Medicare healthcare professional and staff member needs to know.

Considering outsourcing the business side of your practice to a revenue cycle management firm? Let someone deal with the claims and collections headaches … right? Maybe. We examine the pros, cons, expenses, and benefits.

Social networking is all the rage, but be wary if your staff are posting updates to Facebook. Setting a few ground rules can help avoid damage to your practice.

There are many intangibles to consider before sitting at the table with a payer to negotiate reimbursement.

Payers have been investing heavily in technology to help manage data and keep their costs to a minimum.

You’ve got questions - lots of ’em. And we’ve got the answers. We compiled some of the most common practice management questions we hear - from collections issues to dealing with staff problems and so much more - in one place, and got answers from some of the top experts in the business.

EHR companies are increasingly offering billing services, and vice versa. Is this just another way to squeeze money out of you, or does it make sense to combine the services?

Payer requests for refunds for incorrectly processed claims are endemic. But wait! There are some things you can do before you write that check.

Say goodbye to photocopies: Machine-readable cards could make billing and collections easier. When will payers make them widely available?

Which payers should you deal with and which should you drop? PayerView uses real claims data to rank them first to worst.

Appeal Letter for Claims Denied for Improper Bundling

Appeal Letter Justifying Emergency Treatment