Approximately 13% of pediatric claims are denied, according to the 2020 Medscape Annual Physician Compensation Report (www.medscape.com/slideshow/2020-compensation-pediatrician-6012743#10; free subscription required). For the typical practice, this means 13% of your earned revenue is at risk if your automated payment entry system or staff write off denied charges without an effort to determine the cause of the denial and potential actions to recoup the denied amount.

If your practice has experienced financial downturns in 2020 (as many have due to the coronavirus disease 2019 pandemic), it might be worthwhile to ask what happens in your practice when claims are denied. How is it decided whether a denied amount is written off, billed to the patient, or submitted as a corrected claim or an appeal to the payer? (Many contracts will not allow billing to patients for services that were denied for reasons such as lack of prior authorization and may...

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