According to Industry research, one in seven claims get denied, amounting to over 200 million rejections each day. Did you know that 85% of claim denials can be resolved?
The Process of sending appeals is very crucial for Revenue cycle management services. Appealing refers to the process of requesting the payer to review their decision against the denial of the claim. It is important to know that appeals can be made both by the patient and by the provider to the payer. The majority of the appeals are dealt with by the provider’s office, as the revenue cycle is handled by them. A huge chunk of the denials can be reverted by payers by sending on-time and accurate appeals. It is important to know that every payer and plan has a different format of appeal. Appeal processes of different payers are usually available on their website or through the payer portals.
Top denials in revenue cycle management usually require an appeal.
– Medical necessity
– Prior authorization
– Timely filing
– Non-covered service
– Experimental
These are some of the denials wherein an appeal is required. The following are general steps in creating an effective appeal
Quintessence’s way of effective appeals
Quintessence understands the need for timely and accurate appeals for faster payments and that’s why unlike other techs for RCM services we have included the process of appeal among our automation intelligence.
We understand your immediate thoughts, Automating the process of appealing! Is that possible? The answer is yes! Reimburssence our AR workflow automation platform is a state-of-the-art user assisting platform. The tool’s primary motive is to ensure timely and prioritized management of claims in the AR. When Reimburssence detects a denial of a claim it can assist the user with the next course of action needed on the claim. These suggestions are pre-programmed in Reimburssence and hence ensure that the claim is worked towards resolution/payment. If the denial requires an appeal, Reimburssence automatically presents the filled-in appeal form to the user along with the medical records as the supporting document/proof. The user needs to verify the appeal form once before e-faxing it to the payer.
Why Reimburssence for appeals?
– Up to 70% less time is taken for claim action.
– Nil info error in the appeal form.
– Reimburssence can understand situations that require an appeal and assist AR analysts of the same.
– It has a Library that is equipped with all the appeal forms of different payers.
– Assist in sending the right supporting document/medical records along with appeals.
– Timely limits of different payers for appeal submission programmed in Reimburssence. (So that you never miss your deadlines)
The appeals process may seem like one drop in a mighty ocean among the revenue cycle management services, yet it is one of the best resolutions for getting your denials paid. Everyone today talks about optimizing the Revenue cycle management services with automation, AI, ML, etc. But not all focus on the minutes of the process. Quintessence takes this up as a challenge and focuses on developing tools and tech for process nuances that are often overlooked by the industry in general. We take pride in developing solutions that can be unique just for one client and also that resolve their biggest RCM challenge. If you like to know more about Reimburssence or our other suite of solutions click here to schedule a demo.
