AR FOLLOW UP AND DENIAL MANAGEMENT..
We believe that effective Insurance Follow up and AR (Account Receivables)
Management are the most important areas to ensure optimum revenue recovery, accelerate revenues and increase cash flow.
Lost revenue due to denials averages between 6% and 10% of net revenue nationwide.
We have a proven track record to enhance the financial health of our clients.
Consider the following facts:
1. 14% of all claims submitted to payers are denied and have to be resubmitted, appealed or written off by Providers.
2. 50% of denied claims are never re-filed.
3. 90% of denials are preventable.
4. 50-70% of denied claims are recoverable.
This can cost your clinic or practice thousands of dollars every year. Aside from the direct impact from the loss of revenue, there’s an additional impact on resources because of the expense associated with reprocessing denied claims.
Why do I have to face so many claim denials?
We will use Medicare as an example but this could apply to Medicaid or other third party insurance companies as well.
Medicare claims get denied mainly for the following reasons.
* Incorrect or missing ICD-10 diagnoses
* Incorrect or missing CPT-4 modifiers
* Duplicate claim
* Additional information needed to process the claim
* Claim billed amount incorrect
* Incorrect or missing CPT procedure code
* Physician's name and/or UPIN missing or incorrect
* Incorrect or missing place of service code.
Outstanding claims and delayed collections place added administrative strain on a hospital or physician's practice. On one hand, insurance companies often deny claims or refuse to pay them. On the other hand, federal regulations have become increasingly more stringent in the USA. Recently the federal Centers for Medicare & Medicaid Services announced that they would reduce the time physicians are given to file an appeal against a claim denial - from six months to 120 days. This increases the pressure on the staff at your healthcare practice to follow up on denied or appealed claims.