The Ultimate Playbook for Mastering Claims Denials and Winning Appeals
EDUCATION
Regular education on trends, best practices, and lessons learned is vital to prevent repeated mistakes and stop revenue loss from denials and failed appeals. For instance, if a patient’s insurance claim is denied due to a missing modifier, the patient accounts department can fix the issue by adding the missing modifier and submitting the claim again. However, this process is inefficient and time-consuming as it must be repeated for every claim in the future. A better solution would be to learn from this mistake, communicate the error with the team responsible for the initial application of the modifier (such as HIM/Coding), provide relevant education, and verify compliance with follow-up quality checks. This will significantly reduce the number of future denials of the same type and the workload of other departments. Educating adults requires a unique approach, and the educator is encouraged to research adult learning principles. One overarching tenet is that adult learners are motivated to learn when they understand the “why” and will often want to know:
• What’s in it for me?
• Why do I need this information?
• Why does this information matter?
• How can I use this information in a practical, tangible way on the job?
• How will it make me a better worker or professional?
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