Appealing Claims Can Have Appealing Results

Some physician practices don't routinely audit and appeal inappropriately paid or denied health plan claims because they believe it will create an increased administrative burden on the practice. However, not appealing such claims can be quite costly to your practice, according the American Medical Association. Here's why:  

  • You may lose revenue.
  • You may lose the opportunity to recover overhead expenses if you don't have a smooth claims management process.
  • You may lose more revenue later, through future denials. But when you challenge inappropriate claim payments, you show your practice is making an effort to correct the plan's inaccuracy. This could lead to a positive change in the health plan's business practices.

AMA's flyer, How to appeal inappropriate health plan claim denials ( PDF ), lists 12 steps for simplifying the claims auditing and appeals processes and provides links to other helpful publications.

Need help setting up a process to make sure all your claims are paid correctly? TMA Practice Consulting can help. To find out more, call (800) 523-8776 or (512) 370-1418 or e-mail  TMA Practice Consulting .


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