Claim denials and the medical billing staff's approach to these denials can be the difference between average and outstanding collection rates. The basically philosophy is "pro-active" versus "re-active."

The majority of medical billers are already overwhelmed by an endless number of claims management and medical billing tasks. The most common process is insurance payments arrive and the medical biller posts these payments. Insurance denials are often flagged and put to the side to come back to at the end of the week or, a later time.  The problem is that most commonly these denials never get worked and money ends up building up in your accounts receivable. This is an all too familiar tale. Sometimes these denials are an easy fix but often times they are complicated. It's very difficult for physician offices to incentivize their employees to scrutinize these denials.
Understanding that many, even most, claim denials can be reversed critical. Rather than letting a denial sit it should be reviewed and worked at the time of posting.

Are you prepared for the HIPAA 5010 conversion?  

On January 1, 2012, providers must change to a new standard format for submitting electronic claims information or face potential delays in reimbursement. However, nearly half of all practices haven’t even begun implementation, according to a recent MGMA member survey.

The switch from the current 4010A1 format to the new 5010 format requires substantial changes to the claims information you submit. It is extremely important that you are aware of these HIPAA changes and take the necessary steps to be in compliance by the January 1 deadline. If these changes are not made, payers may not be able to process your claims. This could dramatically impact the cash flow of your practice. If you have concerns about this please read-on or contact WorkSmart MD today, 877.672.6221.