Appeal theft.It is important to monitor claims denials and proceed with an appropriate appeal when indicated. (1) You should monitor the outcome of these appeals, not only to track their success but to guard against theft by a staff member who might keep knowledge of a successful appeal to him- or herself. How does appeals theft occur? Let's let's Contraction of let us. say your fee for a surgery is $18,000. Insurance is billed and allows $1,500 but subtracts $250, the amount of the patient's deductible That which may be taken away or subtracted. In taxation, an item that may be subtracted from gross income or adjusted gross income in determining taxable income (e.g., interest expenses, charitable contributions, certain taxes). . You discover that the usual and customary reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. for this procedure should have been $500 higher. Therefore, you appeal and you win. However, if the person in your office who handles appeals is not monitored, the additional $500 might be diverted di·vert v. di·vert·ed, di·vert·ing, di·verts v.tr. 1. To turn aside from a course or direction: Traffic was diverted around the scene of the accident. 2. into that employee's own account. If that person also has access to the patient's deductible payment, he or she can add $250 to the theft by telling you that the patient refused to pay the deductible because the patient was upset with the service. The key to good financial management in the office is a policy of "trust but verify (1) To prove the correctness of data. (2) In data entry operations, to compare the keystrokes of a second operator with the data entered by the first operator to ensure that the data were typed in accurately. See validate. ." Reference (1.) Isenberg SF. Monitoring appeal success. Ear Nose Throat J 2004;83:524. Steven F. Isenberg, MD Dr. Isenberg is an otolaryngologist in private practice in Indianapolis: sisenberg@good4docs Short for documents or documentation. .com
Steps Deposits
Practice's Employee's
Account Account
Primary insurance $1,250 --
pays $1,500, minus
$250 deductible
owed by patient
Appeal results in -- $500
additional $500
payment; check
sent to office
Patient pays $250 -- $250
deductible at
follow-up visit
Totals $1,250 $750
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