Navigating Denial Management and Best Practices in Medical Billing

In this episode, our host addresses common issues and questions related to claims denial in the healthcare industry. The session kicks off with a briefing about the recording process and the host’s recent absence due to business commitments in Europe. The conversation delves into topics such as the upcoming conferences in Nashville, including the RCM Summit and Vive, and moderating panels on collaboration between providers and payers. The Q&A covers detailed discussions on claims denied for timely filing, challenges faced with behavioral health billing, the importance of accurate reason codes, and the complexities of dealing with authorization denials. Specific case studies are examined, including issues with Blue Cross of Massachusetts and UnitedHealthcare denials. The episode emphasizes the need for resilience, thorough research, and the use of technology in managing billing processes effectively.

00:00 Introduction and Housekeeping

02:34 Welcome and Updates

03:45 Upcoming Conferences

04:41 Panel Discussion Preparation

09:54 Q&A: Denial Management

15:28 Common Denial Issues

25:41 Behavioral Health Billing Challenges

31:06 Challenges with Authorization Denials

31:59 Manual vs. Technological Solutions

32:54 Dealing with Out-of-Network Denials

34:54 Frustrations and Resilience in Billing

35:50 Escalating Appeals and Insurance Company Tactics

38:22 Utilizing Support Networks

41:47 Specific Case Discussions and Policies

01:00:04 Conclusion and Final Thoughts