February 3, 2016

The Three R's of Working Your Rejection Report: Rejection, Research, Resubmit

Ah, Rejection. You try not to take it personal. After all, you can resubmit. But there is that little step in between that just fails to inspire interest. Research.

Yes, the steps in working your claim rejection report look like this: Rejection. Research. Resubmit. However, the chore of working the claims which show up on a claim rejection report can be a top office procrastination area.

Rework is never as simple and clear-cut as working fresh claims. Rework can even make your productivity tank for the day. Still, rejected claims can't be ignored without financial impact. And with ICD-10 still impacting data entry and coding assignment accuracy, your rejection numbers are also a key performance measurement. So grab a cup of coffee and try to make the most of it. Here are a few suggestions to making the Three R's of Working Your Rejection Report a little more like righting the wrongs of the day.  . . . . Keep reading this article.

AppealLettersOnline.com Featured Letters

Download the following ICD-10 resources at the  AppealLettersOnline.com Download Library:

Managed Care Contract Renegotiation Request Letter (Updated for Post ICD-10 Implementation!) - Our renegotiation request letter has been redesigned to cite ICD-10 and emerging reimbursement models as a specific justification for contract review and negotiation. The letter can be easily edited to name specific contract language you wish to review/negotiate. Further, the Managed Care Contract Renegotiation letter contains examples of how to cite contract language in appeals so that your negotiation efforts can be more easily enforced via appeals.

Referral Partner Post-ICD-10 Implementation Request Letter (Updated for Post ICD-10 Implementation!) - This letter can be used to notify your referral partners regarding your ICD-10 performance progress. The letter is helpful for situations where you would like more detailed coding information from your referral sources to avoid potential billing mismatch among entities.     

Physician Notification of Updated Physician Query Procedures (Updated for Post ICD-10 Implementation!) - Physician query procedures need to be reviewed and updated due to the ICD-10 impact on physician query volume. Potential changes to the physician query procedures including setting clear deadlines for query responses, new technology deployment for query tracking and a physician escalation policy for unanswered queries.

Access these resources and many more at AppealLettersOnline.com

3 Hour Workshop on ICD-10 Denial Impact And Winning The Appeals

ICD-10 denial management is critical for a healthy 2016 financial picture.  We are currently offering customized ICD-10 denial management staff training focused on denial avoidance as well as successful appeals so that ICD-10 financial impact is minimized.  

We provide both onsite and webinar training specific to ICD-10 denial management.  The 3-hour training session can be customized to your needs but typically covers the following:

Denial avoidance - Get your verification, precertification and clinical documentation improvement staff in tip-top ICD-10 performance. We provide training on verification and precert best practices and payer performance standards to cite when communicating with payers with pre-treatment claim processing inefficiencies. Further, we have specific recommendations for CDI programs involving physician query escalation for an excellent query response rate.

ICD-10 Appeals - Denials will be unavoidable. Make sure your ICD-10  appeals are effective and that your staff understands how to use payer coding transparency to insure accurate ICD-10 claim edit usage. Further, we provide 25 appeal letter templates which cite claim processing and appeal protections required by law. Coding appeals fall in a gray area. Be ready with ICD-10 appeal letter wording specific to ICD-10 denial issues.

Worried about poor quality ICD-10 appeal review? We have appeal escalation recommendations that insure your appeal gets prompt attention. Make sure your payers are compliant with federal and state law regarding denial disclosure and expert-level review of complex coding assignments.  

The presentation includes 25 appeal letter templates specific to ICD-10 denials. Don’t wait to schedule training! Contact Tammy Tipton at 888-399-4925 or t.tipton@appealsolutions.com to schedule a customized training day for February through April. 


ALO University

VRUClass is in session!
Attend one of our audio conferences or on-site training sessions presented by tenured ALO professors.

Not an AppealLettersOnline Member?

Enroll now and immediately take advantage of the many benefits of membership.

Must See Articles

Have Appeals Questions?

Enroll now and take advantage of our  user forums where knowledgeable professionals gather to discuss appeals.

1711 Professionally Written and Effective Appeal Letters

Our Appeal letters give members the edge on appeals by citing potentially applicable regulatory information that demands quality appeal review.  Enroll as a member and access them immediately!

Advertising Opportunities

AppealLettersOnline.com has several great advertising opportunities: banner advertising throughout AppealLettersOnline.com, E-Newsletter advertising and our Virtual Exhibit Hall.

poa125.gif adhere.jpg

Recover Denied Claim Revenue and Collect What is Rightfully Due . . . Starting Today!