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 33 CODING & BILLING Know your rights Many other rights and laws also protect you and your revenue. Learn them. If you haven't been paid correctly, or at all, use one of your most powerful rights, the right of appeal. Request a full and fair review and arm yourself with the facts. Appeal even if a denial is supported by a contract provision. It's very likely a law or right makes that provision unenforceable. Demand specific information and see whether it's valid. And be prepared: Even though you have a right to information and documents, claims personnel often ignore disclosure requests. Insurers make money by aggressively fighting claims. They reward employees for "cost containment." Despite your best efforts, they may stonewall — even after you've clearly shown a claim should be paid. Don't succumb to their strong-arm tactics. The more you let them get away with, the more they'll take advantage. If staffing or other limitations prevent you from spending as much time as it takes to use your rights, get help. Talk to a healthcare attorney or appeal specialist. Always remember: You rendered services in good faith, and you have a right to all the reimbursement you're entitled to. Ms. Dittrich (medrevenue@bellsouth.net) is a revenue recovery and appeal specialist at MedRevenue Solutions in Woodstock, Ga.

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