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process that can have a detrimental effect on your accounts receiv-
able. Most managed care organizations require approval for certain
procedures and admissions; without it, payment will be denied.
Educate your intake staff on these requirements to ensure all patients
receive clearance before they're scheduled for surgery.
Expect denials
Denials will occur no matter how diligent you are. One of the
most common reasons for denial is the dreaded "not medically neces-
sary." Appeal these rejections as they occur, but don't waste your
staffers' time. File the appeal only after you have verified that the cod-
ing is correct, the documentation is adequate and the medical deci-
sion-making is appropriate. Supply the appropriate medical records
and, if possible, include articles, images and a letter from the provider
to support the reason for the service.
Attack your backlog now
If you're drowning in coding-related denials, attack them now
because they can quickly bring in revenue that would otherwise be lost.
Paying attention to corrected claim timeframes and appeals deadlines
keeps denials moving toward the overall goal: payment. Try these tac-
tics to force coding denials appeals back to the top of your to-do list:
Block out time daily to work backlogs, break down the volume of cod-
ing denials into manageable chunks to make the task easier and meas-
ure results at the bottom line. If you track the payments received as a
result of working through coding denials, it'll be easy to make this
tough task a priority.
OSM
Mr. Klitgaard (cklitgaard@medirevv.com) is CEO at MediRevv, a revenue cycle
management company. Ms. Vegter (kvegter@medirevv.com) is an educator for
coding services at MediRevv, and an AAPC-certified ICD-10 trainer.
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Coding & Billing
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