Health Information Management

Tip: Tackle denials with teamwork

APCs Insider, June 10, 2011

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What happens when your facility receives a denial? Does your billing staff just write it off, or do they ask the coders for help?

When coders can't fix a claim fast enough, billers sometimes try to work through the coding and fix it themselves. Even worse, billers who can’t understand the coding on a claim may simply guess or write off the claim.

Billers also sometimes omit diagnosis codes because they don't see a need for them or they know the third-party payer won't provide additional reimbursement. That's a problem because the diagnosis codes support medical necessity for tests or other diagnoses.

When denials occur, billers should consider asking coders to help them craft appeals. Coders spend a lot of time researching complex conditions and coding. Billers can use this that to their advantage when appealing a denial; coders can explain how documentation supports medical necessity and the reason for coding a procedure or diagnosis a certain way.

The tip is adapted from “Coders and billers: It's time to start talking” in the June issue of Briefings on APCs.

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