A large number of questions I receive deal with appealing denied insurance claims and these denials cause most doctors headaches. When a claim has been denied because of medical necessity or because a service is not covered, an important step in the appeals process is to determine if the patient’s plan is a self-funded ERISA plan.
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A couple of weeks ago, I received a phone call from one of our clients in obvious distress. He indicated that his server had crashed and low and behold, both of his backups also failed. Not only did he lose three years worth of electronic patient records, but every patient’s billing information, payments, and accounting. He was obviously the most worried about what would happen if any insurance carrier were to ask for records during this period of time. Little did he know, this was only the beginning of his nightmare.
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In today’s complex and compliance-mandated healthcare environment, we must take the time to cultivate and develop talent in our offices. Training is not an expense but an investment in our business.
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Have you ever thought about or developed discharge criteria for your practice? You may think to yourself at this point, that this could be a waste of time or an exercise in futility. You may think, “Why would I need discharge criteria? I will just release the patient when the pain is gone.”
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