Claim Submission And Appeal

Our billing experts will make sure clean claims are submitted. If there are any rejections, after corrections re-submission is done in a timely manner.Appeals are an important part of the medical billing process. Appealing on a denied claim with sensitivity to its specific timeline is critical for the healthcare provider to recoup money.Our expert team is proficient with account receivable follow up and work aggressively to know the status of claim and use professional tactics to increase collection. Appeals Processing at AGA is done just the right way, in the right time and with the right documents.

Reasons for claim rejection

  • Entering incorrect information for the Provider, Patient, and Insurance.
  • Entering incorrect information for the Provider, Patient, and Insurance. Inputting the wrong codes or confusing codes such as CPT codes, point of service codes, or ICD-9-CM codes.
  • Inputting mismatched treatment and diagnostic codes.
  • Forgetting to input codes at all for services performed by a physician.
  • Upcoding error when physicians or medical coders enter codes into a patient’s superbill for services not received.
  • Under-coding occurs when a physician or a medical coder leaves out codes from a patient’s superbill or codes them for less treatment than they received.
  • Sloppy documentation, A physician might have illegible handwriting, for example, making it hard to assign codes and bill for a patient’s healthcare.
  • Not having access to EOBs on denied claims.
  • Not verifying a patient’s insurance coverage.
  • Duplicate billing
  • Wrong diagnosis

We understand major reason of claim rejection, so we do aggressive account receivable follow up and try our best to resolve issue, so your practice gets paid what you deserve.

We improve your appeals process by

  • We devise an Appeals strategy which is sure to deliver results. It is also a proven way to have you appealing on all the right claims in order to make the efforts worth the returns.
  • We categorize denial by type/person. This practice helps us identify patterns in denials and enables us to streamline the process.
  • We customize every appeal letter based on the type of denial. While we take all the necessary action include important details we quote industry guidelines, CMS and CPT guidelines and the payer’s reimbursement guidelines to give the appeal a higher likelihood for clearance.