Power Your Practice

The Medical Group Management Association (MGMA) found that better-performing medical groups average just a 4% claims denial rate. Is your practice’s denial rate above four percent? If it is, you probably need to stop blaming your payers for those denials and start looking inward at your office’s processes.

One major problem medical billers encounter is when claims are denied for timely filing because each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as 30 days and some can be as long as two years. It is important to follow these guidelines or your claims [...]

Insurance carriers often deny claims for not being coded to the highest level of specificity or they may consider the diagnosis truncated.  As many billers are not coders, they often don’t understand what has gone wrong or how to fix it. What is the highest level of specificity?

One of the most important parts of billing is handling denials. Thousands of dollars a year can be lost in providers’ offices that don’t handle denials. In fact, I saw a statistic once that said 47% of denied claims don’t ever get appealed. That is outrageous! We find that there are three reasons that denials [...]