You can boost your payment stream significantly by using rejected claims as a learning opportunity. Here's how.
You can boost your payment stream significantly by using rejected claims as a learning opportunity. Each time a claim is denied, your team should review the explanation of benefits to determine where the problem lies, says medical practice consultant Mary Pat Whaley. The reason and remark codes provided by the payer explain why adjustments were made to the claim payment.
"This is not something that should be reviewed once a year," says Whaley. "It has to be woven into everyday conversations and monthly meetings."
It's not enough to merely correct the claim and resubmit it, however. All team members involved should be given feedback on why the claim was rejected and how they can submit correctly going forward.
"Closing the feedback loop is very important," says Whaley. "It can't just be someone on the back end fixing everything. The person on the front end also needs to understand why [the claim] was denied and what implication that has for the practice."