Are you appealing? | Appeals and Denials | Health Information Associates

“The biggest victims are the providers.” — Becker’s.

Did you hear about the HHS OIG report?

It confirms that insurers routinely issue improper payment denials — essentially taking money out of your pocket.

The report was compiled using Medicare Advantage data on denials, appeals, and appeal outcomes from 2014 to 2016.

In reviewing hundreds of contracts, the OIG found that insurers overturned 75% of their own denials upon appeal—approximately 216,000 denials each year.

However, while the odds of winning an appeal are seemingly good, many providers simply don’t have the time or the internal staff and infrastructure needed to engage in the process.

In fact, only 1% of denials were appealed during the two-year time period.

That means that 99% of denials were either paid by the patient, or not paid at all.

HIA often assists facilities and physicians with the cumbersome denial/appeal process with a full-service approach.

• Address the overflow volume of denials
• Analyze coding-related reasons for denials
• Provide education and supplemental resources to avoid future denials (including access to our extensive Action Plan Library at no added cost)

Resources

oig.hhs.gov/oei/reports/oei-09-16-00410.pdf
beckershospitalreview.com/legal-regulatory-issues/most-medicare-advantage-denials-really-are-wrong-and-the-biggest-victims-are-the-providers.html