Denial Management Made Easy (Physician Services, HCFA-1500)

Name: Denial Management Made Easy (Physician Services, HCFA-1500)
Rating: 4.6 (54 reviews)

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Created byKateryna Patskovska

Last updated 8/2022

English

What you'll learn

Decrease Denial Rate for your practice by learning about 8 Most Common Denial Types - if/and how you can successfully resolve each one
When to request a claim reconsideration, submit a corrected claim vs an appeal request (w/examples)
Break down of 3 real life case studies of denied claims, and what action to take in order to resolve each one successfully.
Learn the difference between 7 and 8 on HCFA-1500 form when submitting a claim.

Course content

1 section • 10 lectures • 1h 1m total length

Introduction3:01
Learn to reduce practice denials by mastering the eight common denial types, when to submit a corrected claim or an appeal, and the seven versus eight HCFA-1500 form nuances.
Section#1 video18:54
Section#1 Video29:14
Master denial management by validating medical necessity and CPT code pairings, submitting medical notes when needed, and pursuing claim reconsiderations or corrected claims for referrals and authorizations.
Section#1 Video33:28
Identify denial reasons five and six, including timely filing limits, natural disaster reconsiderations, and corrected claim submissions with the proper quantity and 1500 form.
Section#1 Video46:51
Identify denials of missing modifiers and missing information, ensure proper NDC and injection codes with corrected 1500 forms, and grasp proactive handling of retro terminated denials in managed Medicaid.
Section#2 Video14:29
Learn when to file a claim reconsideration or corrected claim versus an appeal, with MVP case examples from New York and Vermont and guidance on online submission options.
Section#2 Video211:04
Section#2 Video34:58
Review a Blue Cross Blue Shield denial for routine care on a patient’s 95004; the Z code caused denial, missing modifier 25. Rebuild the claim and record the reference number.
Section#2 Video47:00
Explore how to draft an appeal letter for Aetna denials, attach medical notes and policy pages, authorization and investigational codes for Zola treatment, and secure payment on a second appeal.
Section#3 Video12:41
Compare seven and eight on the 1500 form, including replacement or correction of the previous claim (box 22) and their timely filing implications.
Denial Management Made Easy Quiz

Requirements

Some knowledge of medical billing and coding

Description

As the years go by the medical claim denials are becoming more of a nuisance for the practices everywhere. According to HFMA: “Providers typically do nothing at all to address more than half of denials. Up to 65 percent of denied claims are never resubmitted. Included in this percentage are denials stemming from commercial health plans, which—according the previously cited research—constituted 58 percent of all denials in 2017, up from 54 percent in 2016. This is money left on the table, and the industry is still looking for solutions to tackle the issue.” In this course you will refresh your denial management knowledge. Find out the 8 most common denial types (any specialty) for physician services (POS 11). Explore solutions to the 8 most common denial types, if they can be successfully resolved (hint: not all of them can). Save time! Increase your collection rate. In addition we will go over 3 real life examples of claim reconsideration/corrected claim and an appeal. These examples will include an online submission (through portal), a phone call and a fax request. Plus do you remember the difference between 7 and 8 on HCFA-1500 form? Reduce time you spend on denials and dedicate more of that time on making your practice efficient.

Who this course is for:

Medical Billers
Medical Coders
Physicians
Anyone that is billing and coding for HBAI Services
Office Administrative Staff
Medical Assistants