by admin | Sep 4, 2018 | Denials, Denials Management, Health Care Finance, Hospital Revenue Cycle, Medical Billing, Revenue Cycle KPI's
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....
by admin | Dec 12, 2016 | Denials, Denials Management, Medical Necessity, Medical Necessity
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...
by admin | Aug 29, 2013 | Denials, Hospital Revenue Cycle, Insurance Claims
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....
by admin | Nov 29, 2012 | Denials, Insurance Claims
Washington Publishing Company Denial Codes Share this: Click to share on X (Opens in new window) X Click to share on LinkedIn (Opens in new window)...
by admin | May 14, 2012 | Denials
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...
by admin | May 14, 2012 | Denials, Insurance Claims
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. Share this: Click to share on X (Opens...
