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Appealing denied claims

As a healthcare provider in San Antonio, you no doubt feel a strong obligation to help your local patient population in any way that you can. Your ability to do that is, of course, dependent upon you being paid for the services that you render. Thus, when you receive an insurance claim denial, it is easy to become frustrated. Often, clients come to us here at The Law Offices of Jessica Taylor PLLC wondering what to do in the face of mounting denials. If you have the same question, it is important to understand that a denied claim does not need represent a final outcome.  

RevCycle Intelligence reports that as many as one in five claims are either denied to delayed. That rate can easily be felt in your clinic's bottom line given that patients will often not be able to afford to pay denied claim balances in a single lump sum. Therefore, your best bet to receiving swift reimbursement for your services is often to appeal insurer decisions. 

How should you go about this? Simple stick to the following process: 

  • Research the claim form to find the reason and remark codes indicating why the claim (or certain charges on it) were denied
  • Educate yourself on the insurer's appeal process
  • Present evidence in your appeal supporting your medical decision-making as well as your documentation and coding 

Evidence can include details as to why you believed a procedure or service was medically necessary, documentation from medical publications supporting your assertions, and examples from coding reference materials showing your proper coding of the claim. If possible, look into whether Medicare and/or Medicaid covers the procedure (either by itself or in conjunction with another service). 

You can learn more about appealing denied claims by continuing to explore our site. 

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
14100 San Pedro Avenue
Suite 602
San Antonio, TX 78232

Phone: 210-265-6759
Phone: (210) 402-4022
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