Denials are a thorn in the flesh for most medical practices. But there are some specialties that have an exceptionally high denial rate. Obgyn is unfortunately one of them. Denial rates in this specialty are the highest at a whopping 22.42%. Denials are an everyday occurrence for most obgyn centers. But that doesn’t mean you need to live with them. Most denials are “soft” and with some effort be easily overturned. The cost of handling a denied claim is on an average $25. It considerably adds up to the administrative and financial burden of a practice.

Recently BiIlingParadise worked with an ob-gyn practice that was facing a financial slump. Upon analysis, we found that their previous biller had no experience in billing for antepartum codes and also repeatedly missed adding Modifier QW for screening services. This led to a high number of denials and a steep downturn in revenue for the ob-gyn practice. The appealing process was extremely tough given that most claims were also way beyond the timely filing limit. This story does have a happy ending. We managed to increase the revenue of the ob-gyn center by 60% within a few months.

Become claim status investigators 

There are so many facets to appealing a denied claim. While each denial may seem the same, each one is definitely unique. I tell my staff that they are CSI agents. (Claim Status Investigators). The first thing I do when a claim is denied is to review the EOB and determine why it was denied.

While this may seem Elementary, I have reviewed too many providers AR where nobody has done anything on the claim and they just resubmit the claim without reviewing why it was denied, or send in an appeal with records when they just needed a diagnosis change, Etc. So the first thing in your CSI investigation is to figure out why the claim was denied and then work backwards how to fix it.

• Julie Bos, CPC, CPB, CPPM
• Manager of Billing Operations
• Clifford Medical Billing Specialists Inc

So what happens when you are hit by the big “D”? This article I came across recently gives some practical simple tips to appeal denied claims. 

If you are interested in reading the entire case study click here.