In spite of Medicare’s attempts to decrease the quantity of Medicare appeals, numerous health care providers and patients continue to file denial appeals, causing a rapid increase in the system, which has created the resulting backlog.
The Government Accountability Office (GAO) released a report on June 9, which analyzed the increased number of appeals in the system causing a backlog at the third and fourth levels of Medicare’s five-tiered review process. These are also known as the Administrative Law Judge (ALJ) and the Department of Appeals Board (DAB).
The report examines the methods of monitoring carried out by the Department of Health and Human Services’ (HHS) and its attempts to diminish the backlog of appeals. It goes on to recommend ways to improve the appeals process to reduce the backlog, such as through “enhanced data collection and more efficient methods to adjudicate certain repetitive claims.”
Concerns continue to grow as appeals become tied up in Medicare’s administrative review process. It was mainly intended for beneficiaries, however, more often than not, denials mostly consist of audits and resulting provider appeals. The Centers for Medicare and Medicaid Services (CMS) attributes the rate of coverage denials to “inadequate medical review and misapplication of Medicare rules.” Basically, claims are being wrongly and unnecessarily denied with little to no regard for the law.
Avoid being denied
The appeals process can take anywhere from 90 days to two years to be settled. According to the American Hospital Association (AHA), billions of dollars is tied up in disputed claims. Healthcare organizations lose money by not appealing, then through lost time and money spent reworking appealed claims.
Even though many healthcare providers blow it off, accepting that it comes with the industry—you shouldn’t simply abandon money that is owed to your practice because the process is arduous. Here are some tips to avoid denials to improve claims reimbursements:
- Use an automated billing software. The advantages include automatic updates, streamlined billing, and ease of access.
- Continuously train staff on payer requirements, coding, and software updates. If your staff is not up-to-date on how to properly use your billing system, then you will lose time and money.
- Consider outsourcing your medical billing to a company specializing in claims and increasing bottom-line revenue.
- If you and your staff are going to manage the claims process, ensure the forms are filled out correctly. The details must be accurate and legible. The slightest error will result in a denial.
- Do not forget to follow up on a denied claim, which is the largest reason many healthcare providers lose out on revenue. You cannot expect to be around for long if you continuously operate in the red.
- Most important, don’t miss any of the deadlines.
Are you losing out on revenue due to rejected or abandoned claims appeals? Allow a professional at Rev-Ignition to assist you with the claims process. Call (844) 297-9944 to speak with one of our certified experts today!