American Medical Association (AMA) news: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

amednews: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

Yes, this is old news, but thought it would be worth posting…

Appealing denied claims seems to work, GAO report says

The government is looking for a way to track and report denial rates to consumers as part of health insurance exchanges.

By EMILY BERRY, amednews staff. Posted April 11, 2011.

• A government review of the rates at which insurers decline to write policies and reject claims for payment found that when physicians and patients appealed denied claims, those appeals were “frequently” successful, with 39% to 59% resulting in a reversal.

The Government Accountability Office report, released March 16, also found that many health insurance claims denials stem from miscodings, incomplete information or other paperwork errors, pointing to the need for further automation of claims processing.

• Links
• See related content

The report examined what the GAO called “application denials” — declining to write a policy for someone — as well as “coverage denials” — deciding not to pay a claim. The Patient Protection and Affordable Care Act called on the GAO to examine both. The Dept. of Health and Human Services, which has started tracking application denials, plans to track and publish rates of coverage denials as part of the health insurance exchanges that will be part of the health reform law, according to the report.

Until HHS tracks application and coverage denials in a comprehensive way, there is limited information available about both. The GAO noted that the American Medical Association helped the authors interpret and understand the limitations of denial data available.

Rejected applications, denied claims

The GAO examined application denial data in the individual insurance market, collected by the HHS during the first quarter of 2010 and from six states that already track denials.

Researchers found that the rate at which insurers declined to offer an applicant coverage averaged 19%, but rates varied widely……

Related articles

• More PPACA Claim Specialists in Demand After the Supreme Court Decision on PPACA In June 2012 (prweb.com)
• Why we need to go from e-patient to i-patient (insurance savvy patient) (jflahiff.wordpress.com)