Clinical Appeals & Denials Management
Clinical Appeals & Denials Management
Clinical Appeals & Denials Management is a critical component of hospital revenue integrity strategy. We assist our clients by ensuring they receive accurate reimbursement for the services they provide through the identification, management and education required to improve claims recovery efforts.
As part of our provider solution, our clinical specialists review claims along with medical records for medical necessity. We identify the services rendered and validate that the appropriate levels of care are billed correctly, addressing issues regarding documentation, lack of medical necessity and plan of care. We manage every step of the clinical appeals process through:
- Review and analysis of denials
- Writing professional appeal letters
- Quality assurance review
- Submission
- Follow-ups
- Reporting & education
Experienced Appeals Specialists
When it comes to the appeals management of clinical denials, knowledge is key to resolving and overturning claim denials. Our clinical appeals team of Registered Nurses (RNs) and Compliance specialists are employed on-shore, and have an average of over 20 years of experience. They hold multiple of the following credentials: RN, CCS, CDI, LNCC, C-DAM, CCS-P, CDIP, CCDS, RHIA, RHIT and various audit and compliance credentials.
Having an in-depth understanding of payer specific medical policies, healthcare statutes and national guidelines, our specialists thoroughly review denied claims, write an expertly written appeals letter, and provide insight and strategies to prevent future avoidable denials.
Focus Areas
- Behavioral Health
- Chemotherapy infusion services per NCD/LCD criteria
- CMS Inpatient only services/procedures
- DOU
- DRG/APR disputes
- ICU
- Inpatient level of care downgraded to Observation status
- Labor & Delivery
- Level of Care & Severity of Illness
- Medical Necessity
- Medical/Surgical
- Newborn Nursery
- NICU levels I-IV
- Oncology
- Outpatient surgeries/procedures
- Pediatrics
- PICU
- RAC
- Rehabilitation
- Telemetry
- Trauma
Free Denials Assessment
Managing denials and appeals in healthcare is tough. That’s why we’re offering a free assessment of your denials management program and clinical appeals workflow. View a Sample Denials Assessment below.
Get in touch with our KLAS Rated denials experts, and take the first step towards recovering revenue lost to inappropriate denials.
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What Clients Are Saying About Us
One of Managed Resources’ key strengths is communication; they are always communicating with us. They are always willing to get on the phone and provide their expertise. Even if we are struggling to write an appeal ourselves, they will help us navigate that and maybe provide language that will bolster the appeal’s outcome depending on the circumstances. – Director
These are these are great findings… really, really happy with it. This is exactly what we were hoping to get, this type of information to take back. Super happy with these results, and that we had substantial findings that we can take back to our teams and show to our executives.
Thank You, Thank You!! I found myself in a huge bind. Inpatient and outpatients accounts in backlog. Reaching out to you saved me. Not only did they provide High Quality Experienced coders, they got my backlog under control/caught up in no time.
CodingAID has worked with our physicians to provide valuable and timely coding and documentation education
I can honestly and without hesitation declare these to be the absolute finest, most thorough, comprehensive and convincing clinical appeal letters I have ever seen in my 25+ year career as a hospital revenue cycle leader.
We were really pleased with attention to detail that was provided to us in the review of clinical appeals management and charge capture It was clear to see that your team knew what they were doing!
The Managed Resources clinical appeals team have been excellent to us! Not only in having such a positive impact in recovering appropriate reimbursement for denials, but for their personal and timely approach to sharing educational tools with us to help prevent future denials. They really provided us with a high quality of service.