RWPS #14 - Denied Claims

 

BB2C-14 Problem Scenario: Denied Claims

Problem Description

 

The number of denied claims (bills submitted to insurance companies that they are refusing to pay) has increased. There are a limited number of days that the bill can be resubmitted for payment.  The bill must be reviewed and the reason for denial investigated and corrections made if there was a billing error.  At the same time, there is a backlog of new bills that need to go out that were delayed because of a computer conversion.  The same staff does both jobs and they are struggling with how to get both portions of the work done in a timely manner to ensure reimbursement.

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