VMG Business Office
Insurance Appeals

The appeals team works to appeal denied claims as well as claims not paid according to contract. The team works from claim denied reports created on a monthly basis with all the denials posted during the previous month. The Claim Denial Action report indicates the denials for which appeals, insurance collections and the departments are responsible. The appeals team functions by payer and works the high dollar denials first, followed by any patterns the staff can determine after sorting their reports by department, CPT code, provider, and type of denial. Our goal is to find the root cause of the denial patterns and work to correct the pattern in addition to getting the claim paid.

The team also works the Expected Payment Report that helps to identify claims that have not been paid according to contract. This is a new tool that we are using to catch thousands of claims that have not been paid properly. The tool still has some bugs to work out but in the first 6 months of use the team has identified about $500,000.00 in underpayments and is working to collect what we contracted for.

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