As vexing as claims denials can be, they're always going to be an issue in fee-for-service medicine. Health insurers have a duty to their shareholders to minimize claims errors, and it's in their interests to avoid paying out moneys they don't truly owe.

To protect themselves, providers need to have robust denials management processes in place. Denials management teams should include experienced medical coders, practice/hospital managers and ideally one or more providers.

Though these processes vary from institution to institution and practice to practice, generally speaking the key aspects of such programs include a) promoting the use of appropriate codes through coaching and continuing coding education sessions, b) tracking denied claims to discover patterns which can be addressed and c) creating protocols for working with health insurers.

How effective these efforts are depends on how prepared the participants are to examine their work habits,, how capable healthcare organizations are of changing flawed processes and how willing the organization is to invest in hiring, training and continuing to educate coders.

SUCKS -

I did "pro bono care" and gave the national payments back to the hospital. But, I made, and stil make, money teaching nationalized docs how to run a private medical practice in their off time. It subsidizes their nationalized payments and is exploding in Finland, Germany, UK and Sweden. Legal and governmental encouraged capitalism, too!

PS: You generally can't sue a socialized doctor; but may sue the private practitioners. IRONY