Less than 16% of Denied Medical Claims will be Reprocessed
Years ago, medical appeals to insurance companies were one off happenstances. Occasionally a payer would process a code incorrectly or deny it entirely; and a biller would grab a pre-loaded appeal template to fill in and mail out – fully expecting an overturned decision within 25-30 business days. Those days, however; are long gone.
The 2019 ACA Transparency PUF data shows that out of 38,195,598 claim denials; over 205,124 internal appeals were reported as filed, with only 32,383 of those appeals being overturned. More than ever, appealing insurance denials or low medical billing reimbursements have to be a top priority for billers across the nation. So how do you make your letter stand out in a pile of appeals where less than 16% will be reprocessed? Pointed appeals with fine details are the most likely to get noticed and reworked by insurance companies. Instead of using a cut and paste type template letter, each appeal must be specifically tailored to individual claims in order to stand out with a higher chance of being overturned.
Utilizing appeal letters that note visit specifics to argue the patient’s need for care is necessary in today’s medical field – but is not the only step that needs to be updated. Each payer has differing appeal steps, and though required, most insurance companies will not initially use a provider of similar specialty to review the first appeal received on a claim. This results in a large number of appeal denials, which often discourages billing companies from continuing to try for additional payments. Being meticulous about using every payer specific resource to ensure each case is fully reviewed by the appropriately designated medically licensed physician is the most important aspect of appealing medical denials.
Appeal Denials from Payer Specific Appeal Policies
No two payers are the same anymore. Most health insurers have their own rules and guidance on how to perform appeals. Some require reconsideration before the appeal, some require specific forms filled out with the appeal, and others outsource their pricing to third party vendors who will only accept phone call reconsiderations or negotiations on their claims. Making sure to stay up to date on each payers specific appeal policies and adapting processes to these updates as they come is the best way to ensure your appeals are effective.
Strategies that Maximize the Medical Billing Reimbursement Appeal Process
360 Medical Billing Solutions has spent the last 21 years perfecting our appeal process, and training teams of advanced medical billers on the best appeal practices for our clients. In 2020 we sent over 6,000 first level appeals and collected over $300,000.00 in additional revenue; in 2021 we are improving our appeals process and plan to double our appeal efforts to add additional reimbursement for our providers. Our specialized appeal letters are individually created and reviewed by our team of Appeal Specialist and taken through multiple levels of appeal processes; each specifically tailored by denial reason and insurance company. This guarantees our denied or low reimbursed claims are given multiple appeal opportunities and are walked through every available process provided by the payer for additional payment.
Working toward advancing provider reimbursement is the professional goal of every medical biller, but at 360 it is a personal achievement to ensure that each of our providers are given the most thorough attention to every one of their claims and claim appeals.
Request a free no-obligation consultation. Find out how 360 Medical Billing Solutions can help you maximize your medical billing revenue and cash flow from strategies that reduce claim denials and maximize reimbursements. Contact us on our website or call 1-405-607-1318.