Outpatient Surgery Magazine

Best Buys - July 2013 - Outpatient Surgery Magazine - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 29 CODING & BILLING Karlene Dittrich, CBCS 10 Things Insurers Don't Want You to Know Learn the keys to fighting denials and fending off refund demands. SNEAK Most claim denials and payment demands are invalid. Every year, it seems, insurers think of more ways to wrongfully deny claims and make inappropriate refund demands. As a claims recovery and appeal specialist, I see it all the time. Sadly, you might not realize that most claim denials and payment demands are invalid. Insurers rely on ambiguous rules, disingenuous contract provisions and ever-changing "policies." They thrive on complexity and confusion, writing contracts that keep provisions open to interpretation — their interpretation. But knowledge is power. Knowing your rights and the laws — things insurance companies would rather you didn't know — puts you in a much better position to collect what you're owed. Here are 10 things to keep in mind when it comes to their motives, your rights and how to collect what's yours. 1 Insurance companies may not be focused on quality care or what's best for their customers. Reports show insurers earn their profits from investments. They're focused on satisfying stockholders, not customers. They closely monitor earnings and their medical loss ratio — the difference between what they pay out and what's left over for administrative expenses and

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