Your A/R manager should take the initiative to research denial codes instead of automatically accepting your carrier’s decision to deny the claim. Even if the denial is legitimate, researching the code can help your center avoid the same mistakes and submit claims that will be fully reimbursed in the future. She says denial codes can be researched in several ways: online, on the phone and through previous denials. “The evolution of carriers’ websites has cut down on the time it takes to go through the A/R and turn around a denied claim because you can see it quicker online,” she says. She adds that her A/R manager “checks websites daily, and once she sees a denial, she looks up what it is.”
The A/R manager should also be ready to use the phone if an online search isn’t sufficient. Ms. David says many denial codes are vague and generic, and if your A/R manager doesn’t understand them, he or she should call the carrier and ask for an explanation. The A/R manager can also look at past claims — either accepted or denied — to determine how your carrier has handled similar claims in the past. If the carrier has typically accepted them, you should look into whether the carrier has made a mistake or you have overlooked something in the claim that makes it invalid. Hiring a manager who will research every denial can increase your knowledge of why your carrier denies certain claims and help you submit correct claims in the future.
Unfortunately, the additional documentation needed to appeal a denied claim still has to be submitted on paper. “We’re still waiting to be able to submit it electronically to cut down on response time,” Ms. Davis says. “Right now, you need to draw up the paper, have someone physically review it, send it to the carrier and get it back after a week and a half.” She says this turnaround time is all the more reason to hire a tenacious manager. Since denied claims take time to turn around, your ASC doesn’t have time to let claims sit and grow outdated.
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