Healthcare employees who handle billing and claims must be certain that all of the information they have for each patient is correct and up to date, and that they receive all necessary authorizations prior to performing any procedures. Additionally, insurance clerks have to be certain that they are using the proper procedure codes and not unintentionally over coding. Should a claim be denied, no matter the reason, it must follow the three steps of the appeals process. These three steps are complaint, appeal, and grievance. By filing an appeal, the claim can be paid when it was previously denied, reduced, or down coded. After the appeals process and decision, if a provider or patient is still not satisfied, the appeal can be taken to an outside authority, like a state insurance commission (Valeruis, Bayes, Newby & Seggern, 2008).
Jacob, J. (2001). Amednews.com. Common coding errors can cost your practice. Retrieved November 9, 2009, from http://www.ama-assn.org/amednews/2001/07/02/bil20702.htm Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated claims process approach (3rd ed.). Boston: McGraw-Hill