Dealing with denied claims is an inherent part of healthcare billing. Although having a plan to address denied claims is a high priority, implementing a plan to reduce the number of denials is just as important. Doing more work up front in the healthcare billing process reduces the amount of re-work needed on the back end.
Q: We are experiencing post-payment audits that result in denials of inpatient claims. Our coders and CDI leaders are vehement that the patient meets MCG and/or coding guidelines, but the payer is using clinical results from the patient as their justification. It seems as if they are ignoring all established guidelines. If these are inappropriate denials, how do we fight them?
Although the diagnoses most often targeted for denials remain familiar, payers’ denials reasons and strategies are constantly evolving. Use fresh approaches and real data to address and avoid denials.
Prevention is better than a cure, but that’s often easier said than done when it comes to denials. Use these expert tips to develop a denials strategy that puts the focus on data and collaboration.
With constantly changing charge items and regulations, healthcare providers need an accurate and compliant source of truth that generates correct charges and defensible pricing. A well designed and maintained CDM...
