Whatever may be the reason, most claims denials are a direct result of staff oversight. We at BillingParadise take pride in our billing and coding professionals, who have been either internally or externally certified in their respective area of expertise, and are perpetually enrolled in continual staff education initiatives, so as to possess the most up-to-date billing and coding guidelines knowledge
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Insurance companies have an approved list of procedure/diagnosis combinations that they would pay for. BillingParadise maintains a database of the approved combinations by different insurance companies. Our experienced coders ensure that the highest paying approved combination of procedure and diagnosis codes are used to ensure maximum payment
BillingParadise also maintains an internal database of rejected and underpaid claims of various carriers to serve as an expeditious source of reference for similar cases in the future. This drastically cuts down our denial management time-frame and puts the money where the mouth is, i.e. the physician’s pockets.
After taking enormous pains to fill out all the demographic details and making sure the diagnoses and procedural codes are in place; if you find out in the successive days that your claims have been denied (despite the in-house billing staff); you are terribly disheartened and moreover it cuts at the heart of your practice.
And in most cases, the in-house staff doesn’t aggressively follow up on the denial with the payer and invariably the claims come to be written off. All of this can be avoided only with a dedicated and enthusiastic denial management team, who can expertly team up with certified coders and other billing professionals to go into the root cause of the denial and detect the problem.
It may be a modifier that is out of place or a combination of codes not allowed under the CCI Edits, or it just could be that appropriate pre-authorization for the particular procedure, as mandated by the patient’s carrier was not obtained at the first instance of the patient coming in.
Call us @ 1-(888)-571-9069 to overcome all the denial payment from insurance companies |
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