Problempart i avoid claims rejectionsa payer may delay or, Ask an Expert

Management Studies

Problem:

Part I: Avoid claims rejections

A payer may delay or deny payment because of inaccurate or missing information in a submitted claim. Many contracts require payment within a specified period of time, for example, 30 days from submission of a "clean claim."

Question 1) How can healthcare service providers avoid claims rejections?

Part II: Ensure payment

The Medicare intermediary has returned a claim to a hospital because of an invalid diagnosis code (OCE-Outpatient Code Edit violation number one). This implies that the procedure performed is not supported by the diagnosis code.

Question 2) What action can the provider take to ensure payment? Solve the given numerical problem and illustrate step by step calculation.

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Operation Management, Management Studies

Category:- Operation Management
Reference No.:- M91163183

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