Ask the Expert: Rebilling Denials
What is the benchmark for number of days for rebilling after claims have been denied or rejected?
Answer 1: The goal is to work a denial within two business days of receipt. “Work” is defined as investigating and resolving the denial. Resolution occurs when the representative has taken action (i.e., forwarded the claim to medical records for new codes, to case management for authorization, and to nursing for appeals, and then rebilled and forwarded the claim for adjustment.)
In addition to tracking the number of days from denial to worked status, it is also important to track activity codes per representative to ensure that the right follow up was done.
This question was answered by: Suzanne Lestina, vice president, client innovation, Avadyne Health, Moline, Il,, and a member of HFMA’s First Illinois Chapter.
Answer 2: I do not recall a specific benchmark related to number of days that follow up should occur after claim denials or rejections. We depend on the workflow set up in our patient financial services department to follow up in a timely manner. My opinion is that follow up should occur as soon as possible. The Hospital Accounts Receivable Analysis (HARA) Report may have benchmarks that may point you in the right direction.
This question was answered by: Caswell Samms, network CFO, Lincoln Medical Center and Harlem Hospital, New York, N.Y., and a member of HFMA’s Metropolitan New York Chapter.
Answer 3: This is a workflow issue and is driven by the triggers in our follow-up system. Ideally, claim denials and rejections should be rebilled the next day.
This question was answered by: Brenda Loper, regional director of access services, Sentara Healthcare, and a member of HFMA’s Virginia/Washington D.C. Chapter.
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