It’s a familiar pattern with payers, the provider wins a front-line denial, then a myriad of payer reviews occur and result in more denials. More provider resources are deployed to fight each subsequent denial, only to be unfairly under-reimbursed at the end of the cycle.
Fighting the Rising tide of Claim Denials: A Physician Speaks Out (from RACmonior)
Listen to Monitor Monday for November 29, 2021. Dr. Jerilyn P. Morrissey has the lead story for this episode of Monitor Monday on how Medicare Advantage plans appear to be bulling providers denying claims and fabricating rules for denials. Dr. Morrissey’s section starts on minute 24:50. Look for the episode titled: Resisting Medicare Advantage Bullies.
Don’t Use Denial Rate to Measure a Payer’s Performance
By Jerilyn Morrissey,...