Description

Part of the revenue cycle process is the submission of clean claims to the insurance carriers for timely processing and reimbursement. Unfortunately, there are circumstances when insurance companies, whether right or wrong, will deny a claim or claim line. In order to receive the reimbursement expected when a claim has been denied in error, most insurance companies require an appeal be submitted for reconsideration of the denial. It is important that these appeals are thorough and explain in detail why the claim should be reimbursed, and the documentation to support the service or procedure should be also submitted to be reviewed by the insurance company. Even in some circumstances, a second-level appeal will need to be submitted. This webinar will explain common denials and the reason codes which should be used by all insurance companies based on HIPAA guidelines as well as what should be included or excluded in your appeals. We will also discuss easy tips on making your appeals as relevant as possible for easy acceptance by the insurance companies.

Learning Objectives:-

• Use denial and remark codes to understand the reason why a claim was denied
• Capture the appropriate documentation to support why the denial is incorrect
• Share with the insurance company what other information is needed for reconsideration
• Create an effective appeal by explaining the circumstances in coding language
• Help the reviewer by sharing as much information as possible for easy acceptance
• Know what forms/formats are needed for a specific insurance company
• Realize the methods of submitting appeals to insurance companies
• Use the 2nd level appeal process when necessary
• Understand what can be done when an appeal denial has been received.

Areas Covered in the Session:-

• Finding and understanding denial and remark codes
• Common denials and how they will need to be reconciled
• NCCI policies that create denials
• Understanding each insurance company’s appeals process
• The appeals process
• Writing an effective appeal
• What should be documentation should be submitted
• Knowing what to do when an appeal is not enough

Who Should Attend:-

• Billers
• Coders
• Claims Adjusters
• Claims processors
• Physicians
• Nurses
• Physicians Assistants
• Scribes
• Managers
• Administrator
• Insurance collectors