Denied claims are an inevitable part of medical billing life, but that doesn’t mean that you can’t fight back and argue for the reimbursement that you’re owed. If an insurance carrier denies your claim, take a close look at their reasoning so that you can take steps to make the appeals process as painless as possible. No matter what practice or specialty you work for, consider these simple tips for getting the most out of your appeals.
Know Your Rights
If your claim gets denied, you have a right to know why. Don’t just accept the loss–ask the insurance company for an explanation if one isn’t already provided. In worst case scenarios, you’re even entitled to see the credentials of the reviewer.
Fix The Errors
Though it may seem obvious, one of the easiest things you can do to get a claim approved is simply fix what’s wrong with it. If the claim was denied because of an error on your practice’s part, do everything you can to amend the issue before re-submitting.
Look Into Exceptions
If the appeal isn’t as simple as correcting an objective mistake, consider arguing for an exception. While this won’t work in every case, some patients have unique conditions or circumstances that may make them eligible for different standards. As long as you can back up your argument with the proper documentation, getting an exception may just be as straightforward as asking for one.
Back Yourself Up
Regardless of how you appeal, make sure you do so with the proper backup. Use any relevant documentation to your advantage, and don’t be afraid to cite other regulatory information such as LCDs, NCDs, and even the Affordable Care Act itself.
Denials are never fun, but they don’t have to be the end. No matter your practice, these simple tips can help you appeal a denied claim and secure the reimbursement you deserve.