Denials
Why Sunbelt RCM?
Every day one in five healthcare claims is denied or delayed.
Sunbelt RCM understands the never-ending battle providers face to simply get paid for services rendered.
We can bolster your internal efforts with our professional resources to get you the revenue you have already earned. Our proven process and disciplined steps make an impact.
Sunbelt RCM Attorneys and Clinicians have 30+ years in both payer and provider experience which includes a long, successful track record appealing denied cases.
Experienced with virtually all denials including Medical Necessity, DRG Downgrades, NOA, RAC, Level of Care, Experimental, Bundling, and Pre-Cert – pursuing both in-network and out-of-network payers.
Sunbelt RCM’s team of dedicated attorneys and consulting clinicians will produce high level of recovery on recently denied and aged denials while freeing hospital staff to pursue current accounts and implement denial prevention enhancements.
65% of Denials Go Unchallenged
All denied accounts are worked or managed by an attorney who also writes payment demands and appeal letters. Our program protocols take full advantage of state and federal statutes and regulations.
Clinicians support our efforts by providing detailed review of medical records and case opinions resulting in clinical analysis used to support medical necessity appeals..
Denials To Consider Outsourcing
- No Authorization
- No Pre-certification
- No Referral
- Not Medically Necessary
- Length of Stay or Readmit
- Lack of Care/Alternate Setting
- Time Filling
- Contractual Underpayments
- Pre-existing Condition
- Non-Covered Service
- Cosmetic
- Experimental or Investigational Coverage Terminated
- Usual & Customary
- Silent PPO
- Refund Request
- Coordination of Benefits/Enrollment
Let us Help
Sunbelt RCM attorneys are well versed in both federal regulations as well as specific state insurance laws and regulations governing healthcare reimbursement in all states.
We are experts at contract interpretation and calculating proper levels of healthcare reimbursement.