Appealing Denied Claims in the Fight for Reimbursement
Providers are fighting to be reimbursed for every dollar. Getting reimbursed properly requires back office staffs to diligently pay attention to changes in payor rules.
Providers are fighting to be reimbursed for every dollar. Getting reimbursed properly requires back office staffs to diligently pay attention to changes in payor rules.
Reimbursement defined
For physicians, reimbursement is about getting paid for what they have already done. After providing services, prescriptions, or advice, they are entitled to payment. For this to occur, medical coders, billers and practice managers must intervene. They try to document the correct CPT codes, with the correct modifiers, in the correct magic formula so insurance company will pay the practice correctly the first time. Otherwise several things may lead to denials such as missed modifiers, insurance-specific codes, new rules, and lost charges.
