Appealing denied claims
Compliance Monitor, January 11, 2006
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The best medicine for denied claims is preventive, but if you must appeal denied claims, Terri Rinker, MHA, reimbursement manager for Community Hospital Anderson in Anderson, IN suggests the following strategy.
Involve everyone in the process. Rinker says appealing and preventing denied claims takes the coordination of many individual entities including registration, case management, HIM/coding, the business office, and the individual clinical departments (e.g., radiology, laboratory, physical therapy, surgery).
Show dollar amounts to obtain buy-in from other departments, suggests Rinker. For example, if you show that your hospital wrote off $100,000 last month due to a lack of documented medical necessity for a particular procedure, the chances that physicians will make an effort to improve their documentation increases greatly. This tip is an excerpt from Strategies for Health Care Compliance.
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