Appeals are a normal part of the medical billing process, but that doesn’t make them less frustrating or time-consuming. There are steps you can take, however, to make the appeals process much smoother and more profitable for your practice.
First, take a bird’s eye view and review your most commonly denied claims, prioritizing both for volume and dollar value. You want to use this information to focus your attention where it’s going to benefit your practice the most. You should also know the cost of appealing claims—that will help you prioritize those claims that will net the most for your practice and will also help everyone in your office understand the importance of eliminating denials before they occur whenever possible.
Be sure your appeals process also addresses priority by payer deadlines:
1. Prioritize by shortest deadlines, then by largest amount due.
2. Draft and distribute a list of payer deadlines to insure your appeals are filed in a timely manner.
Next, develop a standard process for addressing the most common denials that represent the most revenue for your practice:
1. Develop a letter template that can be quickly generated and sent for each appeal.
2. Consider designating specific staff members to handle particular denials so that they can develop expertise in that area and learn to expedite the appeals. Make sure your staff is cross-trained so that denials aren’t delayed by a staff member’s absence.
Each appeal letter should include key information:
1. Patient name and demographics, insurance account numbers and employer information
2. Date of service
3. The CPT and ICD-9 codes
4. A short, clear explanation of what you are appealing (denial, underpayment) and why (explain medical necessity, authorization received, etc.)
Use your template or a checklist to ensure you include all of this key information–it’s easy to leave an item off in the rush of the business day. Make sure you scan supporting materials so that you can easily find and attach them to the appeal letter.
Of course, one of the key steps in the process is to evaluate your most common denials so that you can eliminate them before they occur, as mentioned above. You will want to evaluate your report of most commonly denied claims to make sure you are addressing root causes and avoid the need to appeal to begin with.
If you are using Kareo, you can generate denial management reports that group your denials and rejections by reason and dollar amount, trended over time. This helps you identify frequently recurring denials and rejections that can be addressed through process changes in your practice. For example, if you’re routinely receiving denials because the patient is ineligible for insurance coverage, then you may want to begin verifying each patient’s insurance eligibility prior to scheduling appointments.
But regardless of how you do it, spend time organizing your claims appeal efforts to insure you:
1. Eliminate root causes of denials wherever possible.
2. Prioritize your appeals to insure you are pursuing the highest dollar return.
3. Standardize your process so that it is as efficient as possible.
These steps will enable you to improve the productivity and profitability of your appeal processes, your medical billing, and ultimately your practice or billing service.
Do you have suggestions for ways to improve the appeals process or improvements to the ideas in this article? Please share your comments with your colleagues by using the Comments link below. We appreciate your input!