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DENIAL MANAGEMENT: 5 EFFECTIVE APPROACHES TO SHRINK DENIALS

Claim denials may be nothing unusual in healthcare, but the amount denied actually adds up to a substantial sum in the long run and is a loss of revenue for the practice. Studies have shown that many practices do not appeal to denial as they consider the denial management process expensive compared to the amount they will receive from payors.

This erroneous thinking results in leaving money on the table as statistics show that I in 5 claims is denied. Denial management is, therefore, something that every practice should take seriously.

The quantum of claim denials in a facility can be brought down by following the 5 approaches listed below: (more…)

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WHAT IS HIPAA COMPLIANCE? WHO MUST BE HIPAA COMPLIANT?

The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, is a series of rules and regulations that govern the use and disclosure of protected health information (PHI). HIPAA compliance is monitored by the Department of Health and Human Services (HHS) and enforced by the Office for Civil Rights (OCR).

It is essential that a HIPAA Covered Entity or a Business Associate with access to Protected Health Information understands the rules and how to become HIPAA compliant. Ignorance of rules is no defense against enforcement action.

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METICULOUS ELIGIBILITY VERIFICATION SERVICE CAN CURB DENIALS

Insurance Eligibility Verification Service is an essential front-office process whereby a patient’s insurance eligibility/ insurance coverage is verified to know the extent of benefits a patient is eligible for under their insurance plan. The verification has to be done thoroughly and accurate details obtained. The amount of co-pay that the patient has to bear can be determined through proper insurance verification. Hence it is best to carry out this verification before the patient visits the physician.

At Bristol Healthcare Services, our team of billers will verify the patient’s health insurance and note all the information necessary that will enable us to prepare clean claims. Next, we check with the payor regarding the insurance coverage, the current status of the policy and then follow-up with the patient. (more…)

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