The denial of claims can be though of as two types of denials. First are denials that essentially mean the patient should have never been treated in the first place and no payment can be expected from the payer. These types of denials point to patient intake problems within the practice. These problems take many possible forms but often involve; ineffective insurance verifications and prior authorization processes, improper patient disclosures upon registration, lack of a valid referring physician and diagnosis coding issues. The fix here is all about cutting your losses as quickly as possible and shoring up your patient intake policies and procedures to prevent this from happening in the future.
Second are denials that affect part of a payable claim resulting in lower than expected reimbursement. These when properly responded to can result in revenues that would have otherwise been written off. Most commonly we see denials of this type due to improper use of KX and 59 modifiers. Partial payment denials and underpaid claims share some common ground.
At CRS we document and study denial trends and use this information to improve process and revenues for our clients.
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