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Review EOBs for denial reasons

Ambulatory Surgery Reimbursement Update, April 3, 2007

If you regularly review explanations of benefits (EOB) for denial reasons, they will provide you with a wealth of information about what your facility is doing incorrectly/inefficiently with the billing, coding, insurance verification, and other business office processes.

Make note of denials for reasons such as "no coverage on the date of service," coding denials for procedures that are "a component of another code" (which indicates unbundling), "no pre-cert," and "claim sent to the wrong payer," etc.

Reviewing EOBs for these denial reasons will help you identify gaps and inefficiencies to improve operational processes and possibly capture lost reimbursement.

This tip is brought to you by Ellis Medical Consulting, Inc.

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