Guide to Claim Denial Management

A 2017 analysis found “Healthcare.gov marketplace insurers denied nearly one of every five claims for in-network services.” (KFF, 2019) That is, on average, 19 percent of submitted claims. The same study showed some payers with a denial rate as high as 45 percent. Why are there so many payer denials and what can your organization do to get back the revenue you deserve?

In this guide, Leonta Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC, and a member of AAPC Board of Directors will break down how to retool your denial management program to investigate, categorize, and operationalize your response to payer denials. Subjects covered include:

• Why Are There So Many Payer Denials?
• When Is It Time to Appeal?
• Tips for Managing Denials
• How to Nip Appeals in the Bud

https://www.kff.org/private-insurance/press-release/analysis-marketplace-plans-denied-average-of-nearly-one-in-five-claims-in-2017-with-wide-variations-across-insurers/