Claims experts say to be on lookout for increase in denials

MedRevenue Solutions, LLC’s Karlene Dittrich, a certified ERISA/PPACA claims recovery and appeal specialist, is encouraging medical practices to “keep an eye out for an increase in claim denials, audit attempts, and refund demands involving [Anthem and Cigna Corp.] and to take action to protect your revenue of any potential attempts made to recover their unexpected financial losses” in light of a recent U.S. Court of Appeals ruling that upheld a lower court ruling that blocked the two insurers from merging on “grounds that the combination would harm competition, particularly in the national employer market.”

Bruce Trickel, an administrator with Albany Internal Medicine and the chair of the Georgia Medical Group Management Association (GMGMA) Third Party Payer Committee, adds that, “These companies have to recover the costs associated with this litigation in order to maintain or improve shareholder earnings. The typical method of doing that is through claims denials and, more expediently, through fabricated audit attempts followed by refund demands and non-compliant recoupments – so practices have to be extra vigilant when it comes to processing claims.”

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