Medical Billing Blog: Section - Denials

Archive of all Articles in the Denials Section

This is the archive containing links to all articles written in the Denials section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

Defining the Role of a Medical Billing Clearing House

The importance of a clearing house in the medical world cannot be overemphasized. Also called Third Party Administrators (TPAs), clearing houses make healthcare payment seamless by serving as a link between the hospital, patient, and insurance provider. The role of the clearing house is to interact with the billing system of a hospital, clinic or physician’s office to evaluate medical claims. It sets up necessary documents for patients with claims before forwarding them to the insurer. Typically, a clearing house has strong ties with various insurance providers. Clearing houses aren’t restricted to just collecting documents and ensuring proper documentation for the claim/claims of patients, they are also saddled with the

Published By: Kathryn Etienne, CCS-P, RT | No Comments

The Importance of A/R and Outstanding Medical Claims

Accounts receivable (A/R) management is an integral part of the medical billing process and it is crucial for the financial stability and success of healthcare facilities and medical practitioners. Accounts receivable is referred to as the sum of money owed to the medical practitioner or healthcare provider for the service provided, but not yet paid. The medical services that are rendered by physicians, nursing homes, therapists, laboratory technicians, and hospitals are continuously increasing. An efficient insurance model assists a medical practice in recovering overdue payments from insurance carriers easily and on time. This is when a diligent A/R employee, or department is important, they assist the healthcare provider in being

Published By: Melissa Clark, CCS-P, RT | No Comments

Medical Billing vs Medical Coding, What’s the Difference?

Medical coding and medical billing are two of the reimbursement systems within the healthcare organization. The professionals who perform these tasks are known as medical coders and medical billers, respectively. The work of medical coders and medical billers is to analyze medical treatments received by patients while at a healthcare facility to coordinate payments from insurance companies and patients. In this article, we will discuss the difference between medical coding and medical billing. However, it is important to have a brief understanding of what medical coding and medical billing entail. What is Medical Coding? Medical coding is a way of converting healthcare diagnosis, procedures, medical services, and equipment into universal

Published By: Kathryn Etienne, CCS-P, RT | No Comments

RCM tip: Use an automated solution to tackle claim denials

As healthcare organizations continue to struggle with claim denials, an automated solution can help limit the issue, according to Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company. Mr. Lathrop shared the following tip with Becker’s Hospital Review. “One way to keep denials from happening in the future is by stepping away from the manual processing that takes place at a computer terminal, and replacing it with an automated claims and denials system. An automated system has the benefit of knowing payer codes. Treatment codes change over time and must be kept up-to-date. Keeping track of them by hand is difficult and time-consuming, but an automated solution has the

Published By: Melissa Clark, CCS-P, RT | No Comments

7 strategies to prevent claims denials

Claims denials pose a serious issue for hospitals amid an already complicated reimbursement landscape. “Denials are a huge obstacle to timely and complete reimbursement,” said Carmen Sessoms, associate vice president of the revenue cycle management advisory services program at Nashville, Tenn.-based Change Healthcare. In 2016, Change Healthcare managed 1.8 billion transactions with a value of more than $3 trillion. Leveraging this data, analysts determined approximately 9 percent of claims with a value of $262 billion were denied. These denials impacted about 3.3 percent of net patient revenue, translating to an average of $4.9 million per hospital. Denials are not only highly prevalent in the healthcare environment, but also very costly

Published By: Melissa Clark, CCS-P, RT | No Comments

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