The cure for claims denials.

G reimbursed for the services you provide should be fairly straightforward: provide a service, submit a claim, and receive payment. It sounds simple enough, but a lot can go wrong in this process, from coding and data entry errors made by your practice to complex coding edits made by your payers. The American Medical Association’s most recent National Health Insurer Report Card found that the major payers return up to 29 percent of claim lines with $0 for payment – most commonly because the patient is responsible for the balance but also because of claim edits (up to 7 percent) or other denials (up to 5 percent). Denied claims can be reworked and resubmitted, but there is a cost to your practice. A study by the Medical Group Management Association found the cost to rework a denied claim is approximately $25, and more than 50 percent of denied claims are never reworked. (See “The potential financial impact of denials” on page 8.) Poor management of the claims process can be detrimental to the financial health and sustainability of a practice, so avoiding claims denials should be the responsibility of everyone in the practice. The scheduler must collect accurate demographic and insurance information. Registration must verify the patient’s information. Nurses must accurately enter the patient’s medical data in the electronic health record. Clinical or support staff must note potentially noncovered