Saturday, January 30, 2016

How To Handle A Rejected Claim From The Insurance Company

By Wile Longertons

Years ago, a PhD in medicine meant respect, knowledge and honor. Today, medical doctors are having a harder time with insurance company's respecting them for their expertise. Insurance companies are cracking down on medical doctors and blood labs. The new ICD-10 allows them to do that. Under ICD-9, a doctor could tell the insurance company that their patient needed two blood tests that week without having to explain a whole lot. The medical biller would simply put in the code and the doctor would expect a check in the mail a couple of weeks later. Today, this is not the case. Insurance companies are constantly asking the question of why. Why should I write you a check because you are claiming that your patient needed two blood tests? They want you to document why this was necessary before paying you.

Medical billing audits are becoming more common now. Medical doctors are beginning to see their practices being audited by the insurance company's. The insurance companies are tired of fraud. They often feel that doctors and blood labs are not being honest with them when it comes to their services rendered. For years' patients have been complaining about getting overcharged at the doctor's office. They went in for a simple headache and came out with a bill for $500.00. Were the tests really necessary or could the doctor just have given the patient some headache medication?

Most people don't know that you need to learn 5 times as much information now than you did under ICD-9. You better believe that more study and experience is required. You need to document everything when you submit it to the insurance company. Insurance company's want to know why you are sending them a bill for a certain amount of money. Why should they pay you for the services that you performed? Was the service really necessary in the first place?

The new ICD-10 codes are already showing hard times for doctors. Doctors are seeing their payments being slow from insurance companies. They are often see far less reimbursement from the claims that they are submitting. This is a problem since doctors rely on insurance companies to pay their salary. Most patients cannot afford to write their doctor a check for $200.00 or more dollars every time that they visit them. If the insurance company is not paying for the treatment, then who is?

Medical billers today should understand a lot about anatomy and how conditions are treated. In order to send in a correct claim to the insurance company, the biller must know how to do it correctly. Document what had to be done in detail. Today, the more detail that you give the insurance company the better. You will often see a higher return on your claims in the end. It requires much more work. However, this is why you need someone to do this full time for you. Forget ICD-9. It is a thing of the past. Instead, focus your attention on what needs to be done.

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