Denials and Appeals FAQs Q: When someone completes the number of visits allowed by the insurance plan but wants to continue coming in for care, we create a cash case. Do we still have to charge the contracted rate even though coverage has ended, and we won’t be submitting? A: When a patient completes his/her…
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Navigating the choppy waters of the Appeals Process can be confusing and frustrating at best, but with a little research and insight, you can come out on top when challenging a denial. In the first tutorial, we address general claims, the reasons for denials, when an appeal might be appropriate, how to mount the appeal,…
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Understanding the reason for reactive follow-up isn’t enough. Full implementation of the KMC University Follow-Up system provides the foundation for simplifying the day-to-day operations of the financial department. Properly executing the nuts and bolts of reactive follow-up can be the difference between timely, paid claims, and frustrating accounts receivable. In this operational training, learn the…
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Collecting Other Detail Coverage Documents In addition to Insurance Verification, it is advisable to collect both the Summary of Benefits and Coverage (SBC) and the Summary Plan Description (SPD) for each patient and store these documents where they are easily accessible. This is just another good practice will that help both you and your patients…
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Download Support Tool This support tool outlines the different cogwheels that represent processes for reimbursement success. As you work through the modules in this course, we recommend that you reference this image. Take note of areas that may have been overlooked in the clinic. You can also use it as a checklist. Once you have…
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Have you ever wondered why some doctors are successful while others work just as hard and are always struggling? At KMC University we used to wonder but as we worked closely with a variety of clinics, we were able to identify areas of weakness and as a result, developed the KMC University Financial System. This…
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