The foundation of establishing and maintaining a high collection rate and increasing cash flow is achieved in 3 steps:
Capture charges correctly and timely
Periodic Medical Chart Audits
Appeal Charges Denied by Insurance Carriers
Are you aware that you have recourse to appeal an insurance company’s decision when payment is denied for medically necessary procedures rendered to patients?
Every practice manager and administrator should be made aware of procedure denials by the entity that is performing their medical billing functions, whether billing is performed in-house or by an external vendor.
Insurance carrier denials for medical procedures rendered to patients should be tracked, analyzed and managed by a designated staff member that has a basic understanding of billing and the charge capture process.
A large part of the denial management process is appealing the carrier’s decision not to reimburse for a procedure. There are several issues surrounding the “appeals” process that include; having the time to write a coherent appeal letter, tracking the appeal and responding to the carrier in a timely fashion. It is also important that the person “appealing” has knowledge of both the appeals process and clinical knowledge to explain pertinent issues regarding medical necessity to perform the procedure. The appeal process is as lengthy as it is convoluted.
Instead of navigating the complexity of CMS rules and regulations, why not leave the appeals management process to the expertise of the MpowerMed team? MpowerMed offers the service of appealing denials of medically necessary procedures.
Our “Denial and Appeal Management” division will assist you by reviewing the procedure denial, determining whether or not the denial may be appealed and managing the appeal process. This includes composing custom letters of appeal, corresponding with the insurance carriers and supplying necessary documentation in support of the appeal.
You do not have to be a medical billing client of MpowerMed for us handle your appeals management.
