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Navigating the complexities of billing for palliative care services can be challenging. This guide addresses common questions regarding whether PC visits are billed, the reasons for claim denials, and the process for resubmitting claims. If your services are being denied, it’s essential to understand how to identify billing errors and who manages the billing process within your unit. Equip yourself with the knowledge to review denial reports and improve your claims submission process for better approval rates.
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Are my PC visits being billed? Why Not? NO Are they being paid? YES NO Why are the claims being denied? Billing Error? Same Specialty or group? Hospice Patient? Other? What happens with denied claims? CLOSED RESUBMIT PALLIATIVE CARE CLAIMS ANALYSIS • RESOURCES & ACTIONS • Who does the billing? Ask the manager of the unit for information on the billing process, number of visits billed and not billed. Reasons not billed? • Who logs in payments /reviews denied claims? • Ask the manager for info on claims paid vs. denied. • Ask to see the denial report and meet with the manager to review the denial report together. Can you identify the reasons for denial? • You need to resubmit a “corrected claim”. • If claim is denied again, find who is responsible for filing appeals? Ask the person for number of denials and appeals and results of appeals. Denied Approved Date: 9/15/2008
