Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR). Though sometimes confused for one another, these are separate statistics, each worthy of optimization. HFMA identifies the value of CCR as an indicator of the quality of data collected and reported. […]
Preventing Medical Necessity Denials KAREN HOPPE Although all hospitals must comply with a Medicare requirement that services provided to beneficiaries are reasonable and medically necessary for treatment and diagnosis, the criteria may be inconsistent among the agencies setting them. The Centers for Medicare & Medicaid Services (CMS) created policies that dictate the criteria that […]
Read this report before giving-up on “dead” claims Use ERISA protections to your advantage, make insurers follow the law The Employee Retirement Income Security Act of 1974 (ERISA) requires health insurers to respond to claims in a timely manner. Failure to do so can mean the claim is eligible for immediate payment, explains Richard […]
Washington Publishing Company Denial Codes
Your business office missed the timely filing deadline by 30 days. The claim is filed and comes back denied. What do you do now? You have to make a decision – pursue the patient, write-off or appeal. If the coverage is from a managed care plan, your choices are narrowed to just two. The answer […]
Top twelve Insurance Denial reasons This is a listing from a website that sells denial letter templates. They do have some good information on what to look for (and use to defend) any appeal for a denied insurance claim.