Clemmons, North Carolina 27012, United States
MEDICAL BILLING - AR / CLAIMS RESOLUTION
According to several industry reports, it is estimated that 9% of hospital charges are initially denied. In addition to this, 63% of denials are recoverable on appeal, it costs an average of $118 per denied claim to be appealed. This same study stated that they found medical claims denials are most often associated with problems identified during the front-end processes, as an example, the patient registration/eligibility accounts for around 23.9%, missing or invalid claim data accounts for 14.6%, and the authorization/precertification process accounts for 12.4%. In another report, it is stated that around 70% of the average practice claims are ever paid without having to be worked or reworked through proper ar follow up.
Your top priority is patient care, and our team knows that it is not easy maintaining a practice while delivering the highest quality care to your patients. You shouldn't have to balance the demands of your business with treating patients. So, let us focus on helping you navigate through the ever-changing regulations and payer guidelines. By hiring SRCM, you and your staff can finally relax and focus on patient care, practice growth, and increased revenue. You can finally say "goodbye" to the worry, stress, and hassle of the tedious physician billing, denial resolution, payment posting, and compliance issues.
Just recently, an article from Beckers Hospital Review, dated June 3, 2021, stated that 1/3 of US Hospitals are experiencing denial rates that are considered to be in the "danger zone" .
The reasons according to the article from "Beckers":
- Coding (32 percent)
- Medical necessity for acute inpatient stays (30 percent)
- Front-end processes (20 percent)
References for statistical information:
AR Follow-Up & Claim Resolutions
AR Follow-Up & Claim Resolutions
AR Follow-Up & Claim Resolutions
After a claim is submitted, we continue to follow up with the payer until the claim is properly resolved.
We ensure that every claim is worked within 15 days of billing to ensure that the claim has been received by the payer. With this process, we know that every claim has been properly billed, received and should be processed in a timely matter.
We will continue to follow up on all claims until they have been resolved.
The process that we follow, allows for accelerated resolution of all claims.
During our Follow-Up process, we look for rejection/denial trends, missed revenue opportunities, & coding errors as well as educational opportunities. By doing this, we can help improve your Revenue Cycle.
Claim Denial & Appeals
AR Follow-Up & Claim Resolutions
AR Follow-Up & Claim Resolutions
The highly educated staff at Spinning Revenue will work to resolve any payer denials that require a higher level of expertise for denials and appeals.
Our team will work closely with your office to ensure that the claims are properly resolved. All denied claims, will be throughly investigated against the denial reason. We will first review the denial against the payer policies and guidelines as well as the medical chart to ensure that the claim was denied correctly.
If the denial is accurate, we will research the medical chart and claim to identify any errors for possible corrections. The experienced team will take the necessary steps to file a corrected claim or an appeal based on the payer policy, if appropriate.
Commercial Payers:
- Medical Necessity Appeals and or Audits
- Generic Denial Based Appeals and or Audits
- Coding Denial Appeals
- Authorization Denial Appeals
- Pre & Post Audits
Medicare Payers:
- Appeals (Reopening/Redetermination to the ALJ)
- CERT
- RAC