Addressing Medical Necessity Denials.

1. Addressing Medical Necessity Denials

2. INTRODUCTION As per Cigna’s definition Medical Necessity means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service must be: For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms In accordance with the generally accepted standards of medical billing practice Clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient’s illness, injury, or disease https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

3. Common Reasons for Medical Necessity Denials While there are many different reasons payers may deny a claim as CO 50 (medical billing & coding services or procedures are not deemed a medical necessity), some of them may include: • Lack of documentation necessary to support the length of stay • Service provided • Level of care • Reason for admission https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

4. Addressing Medical Necessity Denials • According to a recent survey report, denials management services cost healthcare practices around $262 billion each year.CO 50 means that the payer refused to pay the claim because they did not deem the service or procedure as medically necessary. • Denials received due to lack of medical necessity are considered as hard denials as it’s difficult to recover the lost payment due to this denial.CO 50 i.e., lack of medical billing & coding services necessary is considered as one of the most common denial reasons. • You can upgrade process flow to avoid further denials but you won't be able to receive insurance reimbursements where you are not able to prove medical billing necessity. It’s essential to not only understand how to solve this problem when this type of denial occurs, but also how to prevent it in the first place. https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

5. When you receive a denial due to medical necessity, reason could be one of the following: • Inpatient criteria not being met • Inappropriate use of the emergency room • Length of stay • Inappropriate level of care https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

6. Guidelines for Appealing Medical Necessity Denials • Why sometimes denials have generic denial codes and it can be tough to figure out the real reason it was denied. Even if you get a CO 50, it’s a good idea to dig deeper, talk to the payer, and get an accurate explanation for non-payment. • Remember to not simply use the original claim number, but append to note it’s a corrected claim denials to avoid it coming back to you again as a duplicate claim. • Even once you resubmit a claim that’s been kicked back for a CO 50 denial, be sure to follow up at least once a month https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

7. Addressing Medical Necessity Denials • When you file appeal claims, ensure appeal letters include the claim number, patient, service date, provider number and member ID. Make the letter to the point and ensure you attach supporting documentation. By having everything correct the first time, you’ll prevent having the appeal denied. • While CO 50 is a common denial code, your billing team should be better equipped to prevent and handle this denial. Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding. We have great experience in collecting accurate insurance reimbursements while reducing claim denials. https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

8. Conclusions: For a clinic to see an increase in revenue, medical billing services must be optimized. It helps to pinpoint potential latencies and boost efficiency. By contracting with experienced service providers for medical billing, you may streamline your billing procedure. They have experience with bills and are aware of all potential areas for error. Making the correct outsourcing firm selection will undoubtedly improve the practice’s billing cycle and increase revenue. What are you waiting for, Medisys Data Solutions is merely one click away!

9. Why choose Medisys Data Solutions for Medical Billing Services? Highly qualified professionals with extensive knowledge of medical and DME billing Easy and hassle-free onboarding for new customers Excellent control over pending, and rejected claims and receivables Communication that is smooth and open at every stage of the medical billing process Devoted, knowledgeable, and certified billing and coding team for your DME facility with top-notch claim management system Your questions and clarifications will be answered immediately and in real-time https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_campaign=Medisysmt

10. About Us Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding. We can assist you in receiving accurate insurance reimbursement from private and government payers. With our services like benefits verification and credentialing & enrollment, you can add more providers in your practice. To know more about our specialty specific medical billing and coding services, contact us at info@medisysdata.com/ +1 888-720-8884 . GET IN TOUCH +1 888-720-8884 Address: Medisys Data Solutions Inc. 8 The Green STE A, Dover, Delaware 19901,USA Email: info@medisysdata.com

11. Thanks Do you have any questions? info@medisysdata.com +1 888-720-8884 medisysdata.com