Learning how to handle denials, rejections and appeals is an important component of working in the healthcare industry. Denials and rejections can happen at two levels; the Clearinghouse or the insurance company. Your EHR system will alert you to whether the error occurred at the Clearinghouse level. If this is the case, there will most likely be a mistake in the documentation and you simply need to fix this and resubmit the claim. On the other hand, if the claim is denied at the insurance provider level, it will most likely be due to a more complicated reason. Some of the most common denial causes include missing a deadline, inaccurate ID, inconsistent data, and non-covered services. When you are fixing your denied claims, you need to be thorough and careful before efficiently resubmitting them. On the other hand, if your claim requires an appeal, there will be certain files that require filling. Contact a customer service representative and determine the steps you need to take in order to appeal your claim. Navigating denials, rejections, and appeals are undoubtedly the most complicated and difficult aspect of the billing process, but with the right amount of care and timing, there’s no reason why your claims won’t be processed effectively, leading to fast payment and good reviews.
Take home message
Billing is complex and it can take counselors a lot of time before they feel comfortable with the process. Receiving timely payments is reliant on a good understanding of billing, client transparency (including informing patients about pricing updates), and knowing the relevant CPT codes. Provided you put in the effort to familiarize yourself with how to complete your claims carefully and submit them on time, there is no reason why you would experience rejections or denials. Learning how to effectively navigate billing will not only lead to faster payments, but will also demonstrate good organization and communication, facilitating the growth of your counseling practice.