How to Appeal Denied Claims

Julie McCoy, for HealthLeaders Media , January 10, 2011

To get the most bang for your buck when appealing, Parsons recommends grouping claims into categories and appealing them in batches. Don’t wait for a number of claims to stack up. Rather, group your denials into categories that can be covered with one appeal to the payer. You still have to be careful not to let claims sit so long that you miss the deadline, she says, but for high-volume practices, this type of grouping can be more efficient than appealing them one at a time.

“If you have many claims that were rejected for the same reason, and you’re going to appeal each one with the same explanation or additional information, you can group them,” Parsons says. “This doesn’t mean just putting off your appeals until the stack gets too big to ignore, but rather it’s a matter of making the most of your time and resources.” 

Source---Adapted from Managed Care Contracting & Reimbursement Advisor, November 2010.

Know when to cut your losses with appeals

Appealing denied claims requires tenacity, but when do you know enough is enough? If you are appealing a denied claim but getting nowhere with the payer, how long do you keep at it?

The answer will vary depending on each situation, but there definitely will come a point when further efforts are not justified, says Shelly Cronin, CPC, CPMA, CANPC, CGSC, CGIC, director of business and member development for the American Academy of Professional Coders in Salt Lake City.

“Every time you handle that claim, it costs you money,” says Cronin. “If it’s been touched so much that by the time you win the appeal you’re not even covering the costs of the appeal, then it is really beyond the point where you should continue.”

Providers often don’t realize how much they are expending on the appeals process, says Bill Gilbert, president of AdvantEdge in Warren, NJ. Gilbert’s company has analyzed the cost of appealing a denied claim, including physician and staff time for researching the case and preparing the appeal. The figure came to an average of $50–$100 per appeal, he says.  

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