All standards used in healthcare reimbursement are defined by the US Department of Health and Human Services. All of the regulation is managed under the Centers for Medicare & Medicaid Services. This entity handles all fee schedules for all services, equipment and supplies associated with healthcare. Reimbursement providers manage the medical billing process, handling these matters for both medical and private entities.
How Denied Claims Work
A denied claim differs from a rejected claim in many areas. A claim must first be processed and denied in order to trigger the claim rework process. There are numerous reasons for a claim being denied. A claim can be denied when a payer-patient contract is denied. If an appeal is submitted and resent for processing, the process delays the healthcare reimbursement process. A denied claim has to be deemed unpayable by the insurance company. The reason for a denial is often explained in the Explanation of Benefits when the claim is denied and returned. Usually, minor errors and clerical oversights are the culprit for these claims errors.
Reworking a Medical Claim
Although a denied claim can certainly be reworked, the company can take steps to ensure that there error rate is reduced. Getting the billing correct the first time is essential in maintaining solid revenue for a company. When a claim needs to be reworked, revenue is impacted. This can make the process cumbersome and delay receipt of funds.
Reworking a Medical Claim Costs Providers
The legal process can be quite involved and costly for providers. Having a reliable healthcare reimbursement company ensures that all reimbursements are handled accurately and efficiently. A compliant medical billing services company like Advanced Reimbursement Solutions guarantees that all billing satisfies all legal requirements and mandates and takes steps to minimize chances of claims rework. Putting our industry expertise to work for your business will enhance revenue and help shorten a provider’s revenue cycle.
Advanced Reimbursement Solutions has offices in Phoenix and Wilmington. Contact us today to learn more about our process!