Heal the Claims Process Campaign: Physician Practices Experience the Saving
Learn about the savings physician practices have experienced by reviewing and appealing inappropriate delays, denials and reductions in claims payments; implementing practice efficiencies; and reporting unfair health insurer practices.
- One practice in Chicago recovered $19,000 over 6 months from appealing a single type of underpaid claim.
- Within five months of implementing an effective auditing and appeal process, one practice in Chicago was already recovering as much as $100,000 per month.
- Health inusrers consistenly underpaid one practive in Chicago $928.50 per claim for a commonly perfromed procedure. Implementing a claims auditing and appealing strategy could enable this practice to obtain accurate payment on these claims.
- A small spinal surgery practice in New Jersey routinely reviews and appeals inappropriate claim denials and reductions in payment. "I appeal everything. I don't give up. The money that I get [as a result of appeals] more than pays for my salary," reports the practice's biller. For instance, one health insurer recently reduced payment on a specific claim. After calling the insurer several times and getting no results, the practice sent a complaint letter to the CEO via certified mail. As a result, the practice was paid the additional $17,500 the insurer owed. The practice's biller submits level I and, if necessary, level II appeals to health insurers. If that doesn't work, the biller then complains to the state Department of Banking and Insurance. "It's time consuming, but it pays off. It more than pays for itself."
