Denial Management & Appeals

At Priority Medical Billing, our skilled billing professionals help you manage denied claims and navigate the appeals process when needed. We help get your claims approved promptly without the hassle of handling paperwork, follow-ups, and stress.

Claims denials are a common challenge for medical practices, but they can seriously impact your practice's revenue and patient experience. When a claim is denied, the responsibility of covering costs often falls on your patients, which can lead to a negative experience for them.

Moreover, figuring out the reason for the denial, correcting it, and reapplying or appealing can consume a lot of time, energy, and resources. This not only affects your overall efficiency but can also harm your financial health. Unpaid bills can hurt your bottom line.

When your claims come back rejected, they are not just an administrative inconvenience; they can significantly slow down your practice’s cash flow. Medical claims can be rejected for various reasons, such as:

• Incorrect or outdated coding
• Missing or incomplete information
• Issues with insurance eligibility 
• Authorization problems

If not addressed quickly, rejected or denied claims can lead to serious consequences for your practice, including:

• Lost revenue: Unresolved denials mean unpaid claims, directly affecting your bottom line.
• Increased administrative costs: A lot of time and resources are needed to identify the reason, correct it, and reapply for denied claims.
• Delayed payments: The longer it takes to resolve rejections, the longer you have to wait for payments.
• Patient dissatisfaction: Billing issues can frustrate patients, leading to dissatisfaction and potential loss of business.

With the right and proactive approach to denial management, you can avoid many of the common pitfalls that slow down your revenue cycle.

We take a proactive, hands-on approach, addressing denials immediately and efficiently. Our streamlined denial management process resolves issues swiftly and accurately.

The moment a claim is denied, our team jumps into action, treating it as a top priority to minimize any delays in your cash flow. With our experienced team of professionals managing your claims, you can have peace of mind knowing your claims are in expert hands.

Our team proactively tracks the status of all claims. When a claim is not processed within a set timeframe, we follow up directly with the payers. If we encounter a denial during this follow-up, our team quickly steps in to resolve the issue.

When a claim is denied, it does not sit in a pile waiting to be addressed. We do not wait for monthly reviews to address denied claims. Our team prioritizes these claims as soon as they come in.

We perform routine checks and carefully review explanations of benefits (EOB) and electronic remittance advice (ERA) statements to assess the cause of the denial.

By tackling denials quickly, we prevent minor problems from growing into larger, more costly delays. Our priority-based approach helps ensure that your cash flow does not suffer from unnecessary setbacks due to slow response times.

When we spot a claim denial or rejection, our first step is to categorize it based on the reason behind it. This analysis helps us identify patterns or trends, revealing any systemic issues that might be causing repeated denials.

Once we have pinpointed the reason for claim rejection, be it a coding mistake, missing information, or a documentation issue, our team makes the necessary corrections. We have the expertise to resolve a wide range of claims issues, ensuring that all necessary adjustments are made to meet payer requirements.

Our skilled billing professionals meticulously review every detail to ensure that the resubmitted claim is accurate, complete, and ready for approval. This thorough approach increases the chances of getting approval on the first refiling.

When appeals are needed, we handle them for you. If an insurance company denies a claim that should be approved, we step in to contest that denial. Our team takes care of all the necessary paperwork to ensure your claim gets another look.

With our extensive experience in the appeals process, we know how to present your case effectively, increasing the chances of a positive outcome. By handling these appeals for you, we not only simplify the process but also improve the overall patient experience.

Effective communication is key to getting claims approved. That’s why we keep an open line of communication with your office.

If there is an issue with a claim - like terminated policies or incomplete information - we contact you immediately so we can resolve it together. When requested, our team also regularly updates you on the status of your claims, so you are never left in the dark.

We ensure that issues are dealt with efficiently and everyone is on the same page, making the entire process smoother and more efficient.

At Priority Medical Billing, we ensure your practice gets paid promptly without the stress of managing claim denials and appeals on your own.

You can access a range of benefits by outsourcing your claims management to us. 

• Reduced denial rates: Our meticulous attention to detail helps avoid claim rejections. We also conduct thorough reviews to identify and resolve systemic issues that could lead to denials.
• Improved cash flow: Timely resolution of rejected claims means more consistent cash flow for your practice, giving you more financial stability.
• Less administrative burden: We handle the paperwork, follow-up calls, and appeals, freeing you from administrative hassles. This allows you to focus on what truly matters, caring for your patients.
• Expert appeals handling: Navigating the appeals process can be complex, but our experienced team knows how to maximize your chances of approval.
• Enhanced patient experience: Claim denials can leave patients facing unexpected bills. By efficiently managing these denials, we help ensure timely payments from insurance companies, reducing stress for your patients.

At Priority Medical Billing, we offer expert medical billing solutions tailored to meet the needs of your practice. Our team has the expertise and processes in place to manage denials efficiently and get your claims approved.

To find out how we can help your practice, please call 708-362-6080 or fill out our online form.