Unformatted text preview: clerks have to be certain that they are using the proper procedure coded and not unintentionally over coding. Should a claim be denied, no matter the reason, it must follow the three steps of the appeals process: complaint, appeal and down coded. By filing an appeal, the claim can be paid when it was previously denied, reduced or down coded. After the appeals process and decision, if a provider or patient is still not satisfied, the appeal can be taken to an outside authority, like a state insurance commission (Valeruis, Bayes, Newby and Seggern, 2008). Reference Jacob, J. (2001). Amednews.com. Common coding errors can cost your practice. Retrieved May 14, 2011, from http://www.ama-assn.org/amednews/2001/07/02/bil20702.htm Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated claims process approach (3 rd ed.). Boston: McGraw-Hill....
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- Spring '11
- appeals process, Newby, Seggern