How to Manage Claim Denials in 2022: A Q&A with Billing Expert Jan Lasker

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Did you know that, according to the Center for Medicare and Medicaid Services, as many as 30 percent of all healthcare provider claims submitted to insurance are denied, lost or ignored on the initial submission? What’s more, less than 25 percent of practices appeal those denials.

For many providers, this amounts to more than just a nuisance. It creates a major revenue cycle management barrier due to revenue loss, slowed cash flow, and additional costs.

The good news is, strategies exist to help providers stand their ground with payers, collect monies they are owed and reduce future claim denials. The following Q&A with MMG Revenue Cycle Manager and billing expert Jan Lasker can help you take back control over your insurance claims and increase revenue in 2022.

Q: Can you explain your role at MMG and your billing experience?

A: I’ve worked for nearly 30 years in physician office management and billing, and over that time I’ve managed billing and coding for various clients. I’ve overseen billing system setup, written and administered department policies and procedures for billing practices, consulted for physician practices on revenue cycle, billing management and coding processes and worked to educate physicians and office staff on best practices. Essentially, when it comes to billing, I’ve seen it all and have an extensive track record of helping practices manage their claim denials and proactively improve their billing.

Q: How does the relationship between providers and payers work? What challenges do you see clients dealing with most often when it comes to payers?  

A: Providers bill for the services provided to patients and expect that the payer will reimburse according to the contract between them. The challenge is ensuring correct payment is made due to ever-changing payer reimbursement policies, and making sure to follow up it you think the claim was paid incorrectly. If you don’t stay on top of these things, your revenue could be affected and it could become quite costly for your practice.

Q: What holds so many providers back from appealing denials?

A: This varies by provider, but for many, the main factors are resources and time. Each payer has its own appeal process, be it a form to fill out by mail or online, phone call, etc. Billers must be knowledgeable of payer policies and processes for appeals in order to correctly respond to claim denials or improper payment, plus keep up with all payer updates and changes, which can be taxing for practices. What’s important to remember is that:

  1. Despite the upfront investment of time, energy and resources, denial management is a worthwhile endeavor that can help your practice realize significant revenue improvements.
  2. The more you appeal denied claims, the less likely the insurance companies are to deny them in the future for illegitimate reasons. Insurance companies assume that a quarter of practices will not appeal, so be a part of the 75 percent that does take a stand and you’ll reap the benefits.

Q: If a provider is hoping to get back on track with billing and denial management in 2022, what are the steps they should take to get started?

A: Great question, and kudos to practices looking to improve their billing and denial management in the coming year. Here are the areas to focus on to get started:

  1. Audit your existing claim denials to get an idea of revenue lost and establish a baseline. In order to track progress, you need to know where you began.
  2. Check to ensure your tools and operational systems are up-to-date. Are you using the most current versions of CPT, ICD-10 and HCPCS? If not, upgrade before moving forward.
  3. Review your current codes and modifiers to ensure you are using them appropriately. Make sure you are utilizing the Correct Coding Initiative (CCI edits).
  4. For payers with a formal appeals process, educate yourself on your appeal rights and the various steps involved in the process.
  5. If possible, assign staff to monitor and review the payer bulletin updates and communicate any changes to the broader team. Keeping track of payer policy and reimbursement changes is critical to ensuring your claims are clean in the first place and, if denied, are quickly appealed and corrected.
  6. Develop a relationship with the provider representatives for the different payers. Oftentimes, providers who build a friendly and professional rapport with payer reps receive better one-on-one attention on denials issues and forenotice of changes in requirements.
  7. Don’t give up if the appeal is denied. When you have done all you can in the battle with the insurance carrier, consider contacting the Department of Insurance.

As you take on your billing and claim denials this year, keep in mind that insurance companies are in business to make money. Advocate for your practice and, when needed, enlist the help of outside experts to collect the money owed to you. If you do, you’ll be well on your way to reducing your denials and increasing revenue.

Jan Lasker is a Billing Manager at Medic Management Group. Jan has been with the team since 2008 and has 29 years of experience in physician office management and billing. She received her procedural coder certification from the AAPC in 2004, a family practice specialty coder certification in 2011 and ICD-10 certification in 2014. She is also a member of the American Medical Billing Association. MMG is a national provider of consulting services and back office administrative support to independent and system owned physician practice groups.  Additionally, MMG has been formally recognized as a multi-year Northeast Ohio Top Workplaces award winner.

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