Nitin Chhoda Reveals New Information to Resolve Claim Disputes

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The majority of reimbursement denials can be dealt with quickly with a simple phone call, but there are instance where additional steps need to be taken or a formal appeal must be filed. EMR expert, Nitin Chhoda, revealed new information for clinicians on resolving disputes and how electronic medical record (EMR) software can facilitate the process.

EMR physical therapy

Chhoda noted that practice owners will be required to prove why a particular claim wasn’t approved for payment. The difficulty could be the result of a mistyped number or letter, or the problem could be with the payer’s software.

“There are dozens of reasons why a claim can be denied or rejected,” said Chhoda. “It’s usually a small error or mistake and an EMR will virtually eliminate those types of problems. An EMR can assist with more serious issues, but it may also require filing a formal appeal before the practitioner gets paid.”

Clinicians contract with multiple payers, but most denial and rejection problems will originate with commercial healthcare insurance providers. Chhoda noted that practice owners will be required to prove why a particular claim wasn’t approved for payment. The difficulty could be the result of a mistyped number or letter, or the problem could be with the payer’s software.

EMR physical therapy software systems are capable of identifying potential errors before claims are sent and eliminate problems before the reimbursement request ever leaves the office. If a denial is received, an EMR allows practices to maintain essential documentation of all attempts to rectify the rejected claim.

There are three basic steps in the dispute process, though clinicians or their medical billers will find that each option may require multiple communications before progressing to the next level.

  •     Call provider relations and be prepared to file a formal written appeal, or submit an online reconsideration, depending on the requirements of the individual payer;
  •     Contact the provider representative;
  •     Submit a formal appeal in writing, clearly stating all the information pertinent to the claim;
  •     When all else fails, refer the matter to an attorney.

It’s imperative that practitioners or their representative have detailed knowledge of the contract terms between the clinician and the payer. He said the way the dispute is approached is just as important as having extensive knowledge of the contract and rejected claim. He advised clinicians to exercise calm and remain professional at all times to facilitate the process for a beneficial conclusion for the practice.

The new information offered by Chhoda provides clinicians with the basic steps involved with disputing reimbursement rejections. Most problems can be resolved with a phone call and that’s always the preferred method, but practice owners should be aware of other actions that can be taken to ensure they’re paid.

Chhoda’s office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.

About Nitin Chhoda
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of "Physical Therapy Marketing For The New Economy" and “Marketing for Physical Therapy Clinics” and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention.

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Nitin Chhoda
EMR News
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