Practice Management Alert

If you’re still having trouble with appeals, look to these simple fixes.

Be Timely in Your Appeals

While the timeline ceiling for getting appeals in may seem expansive, you’re doing your patients and practice a disservice — and creating more headaches for yourself — if you let the denials languish on your desk.

“File your appeals within 45-60 days after you receive the denial. This may go beyond a payer contract or against many consultants that I know who will tell offices 180 days; I disagree with that. The fresher the claim denial, the better chance you have of it not being archived in the payer system,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at CodeCast, in Laguna Niguel, California.

Starting early gives you the time you need to pursue all avenues of research and preparation. This may involve researching regulations — including provisions of the Affordable Care Act, for example — as well as speaking to the patient, pulling reports, scrutinizing documentation, and fully understanding what you’re looking at.

“Have all of your ducks in a row before you submit the information,” Fletcher says.

Send to the Correct Department

If you’re sending your appeal requests to the same place you’re sending initial claims, yet not hearing back, your requests may be getting lost in the system. Luckily, there’s an incredibly simple fix: double-check the address for the particular department you’re trying to reach.

“Make sure you’re not sending appeals to the claims post office box where you’d submit a claim. There’s a different department for this, so that will get lose in the shuffle and they will not address that issue. Always keep that in mind,” Fletcher says.