Claims can be delayed or interrupted at any place in its lifecycle. For many organizations, this is unnoticed – the claims fall into a ‘black hole.’ However, with quality controls and accurate reporting tools, this issue can be remedied. The impact of rebilling claims, such as duplicate denials or rejections, are typically are the root causes of increased cost and lost revenue.
Organizations with a complex payer mix such as Medicaid, Medicare, managed care and commercial can benefit from learning the denial matrix and cross-mapping used by each payer to avoid denials and duplications of claims. It is also advantageous for the A/R staff to be trained on the appropriateness of effectively rebilling claims, and the timeframe it takes to resolve them. Claims rejected by the clearing house are mailed to the address on the claim. If the address is incorrect, the claim is returned to the sender as undeliverable mail. Incorrect claim submissions, electronic or paper, is costly to an organization in such areas as claims, mailing/returned mail, and FTE working denial /reject backlogs. If a claim continues to be denied after several submissions, it can fall into the bucket of lost revenue due to missing filing deadlines.