Ensuring Reimbursement and Healthcare Revenue Integrity Through Effective Appeals

Jul 8, 2020 10:23:10 AM / by Aspirion

Approximately 5-10% of medical billing claims are rejected each year. These claims are extremely expensive to rework, requiring resubmissions and hindering productivity. To maximize revenue integrity, facilities must start by identifying how their denials are holding them back. Our white paper gives you four simple tips on how to overturn denials.

Appeals often fall to clinical staff members who aren’t actually trained in effective appeal writing, like nurses or nurse practitioners. Concise, eloquently written appeals are more likely to gather reimbursement for denied claims.

Clinicians are not always informed on the legal nuances involved in writing appeals. This is why it is important to have someone on your team with legal experience who can write a persuasive, effective appeal letter to payors. If your facility cannot prove to the payor that reimbursement is required, the claim will come back denied no matter how many times you submit it.

Effective revenue cycle management
While physician advisors have great success writing appeals, they are not always cost-effective, especially for facilities seeking a marked difference in revenue. To optimize your denial management, you must deploy a team of specialists devoted to each claim.

Your clinicians might have an excellent understanding of the healthcare system, but if they are not experts in the legal side of revenue cycle management, your appeal will still fall short. An appeal must go beyond stating the facts and instead persuasively explain why the care process meets the terms of the contract your facility has with the payor.

Hiring an external healthcare revenue integrity partner to overcome an onslaught of denied medical claims allows your facility to focus on other issues—leaving the appeals writing in the hands of experts.

At Aspirion, we specialize in denials management. Our team of attorneys and clinicians will empower you to achieve the best possible results. Download our complete denial management white paper to read more tips and best practices.

Tags: Denial Management, Complex Claims


Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, health systems, and large physician groups looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.