According to a recent study by the Health Insurance Association of America, 14% of all claims submitted to payers are denied - that is one in seven that need rework, resubmission, and possible appeal by the provider. The same study found that six percent of EDI claims are rejected even before entering the payer's claim system, and these are not even counted as denials.
Typically only half of all first denials are ever appealed.
Studies show that 45 percent of all first denial appeals are won.
50 percent of second denial appeals and 10 percent of third denial appeals are won
Medical Coding Audits
- Reduce the quantity of denied claims
- Receive fewer claim errors
- Identify and eliminate common mistakes
- Examine the top reasons for denial
- Develop a process improvement plan
- Implement methods to prevent common denials
Registration Error Correction
Registration errors can unnecessarily slow claim payment or cause claims to be unpaid entirely.
Our expert staff can review and correct registration errors to save you time.
Top 5 Registration Errors Resulting in Unpaid Claims
- Incorrect spelling of the patient's name
- Incorrect social security number
- Incorrect date of birth
- Incorrect insurance card contract number
- Incorrect sex of the patient
RAC Audits
ICD-10
Denials Management
Medical Chart Auditing
Medical Coding
Claims Management
Consulting Services
Staff Training
Presentations
Resources
Faster Reimbursement