Denial Management Archives

threetipsonmanagingreimbursementcuts

On July 8 2015, CMS released the 2016 Medicare Physician Fee Schedule proposed rule which, if finalized, would drastically cut reimbursement rates for colonoscopy and other lower GI endoscopy procedures. Can your afford such cuts? Whether or no1t the proposed reimbursement cuts take effect, gearing up for the worst case scenario is the best way going forward.

Here are three tips that will help your practice plan better should the cuts be implemented (or not):
1. Same day claim submission: Many ambulatory surgery centers and specialty practices have specific days in a week when claim submissions happen. This results in an overwhelming number of claims pending to be submitted. To catch up with the piling claims, practices often resort to a rush job with lack of quality checks, not following billing guidelines, resulting in a growing number of denials. As a result, they face uncertain reimbursement patterns. Set an internal benchmark of clearing claims within 24 – 48 hours of the date of service.

2. 90+AR at 5%: Accounts receivables is mostly where the money lies. As with same day claim submission, also resort to same day denial management. Take relevant action on denials as soon as they occur. This is your best bet to get accounts receivables under control. Aim for 90+ AR to be at 5% to avoid reimbursement disruption.

3. Accurate medical documentation: At the onset of reimbursement cuts, it becomes extremely crucial that each claim be processed and paid accurately. On many occasions insurance companies ask for supplementary medical documentation prior to processing the claims. Adopt case specific documentation methods vs. templated approach. The benefits are twofold – the turnaround time for such claims to get paid is relatively less (as there is no back and forth with the carriers on missing/incorrect documentation) and it establishes your practice as a place for getting patient centric medical care.

The above tips can help optimize operations irrespective of reimbursement cuts. Not only does the payment cycle becomes more predictable, but also, provides clarity on the overall health of the practice. Have suggestions of your own? Let us know in the comments below.

Image: Tax Credits/Flickr

reducedenialsin5steps

Tracking and reconciling denials are extremely crucial for every medical practice. They form a metric for practice performance and are a direct reflection of reimbursements. They also reveal loopholes in practice operations.

Practices typically decide a day/s on which they would act on denials. For example, if a practice decides to work on denials every Friday, the denials don’t wait for Friday to pop up. They keep accumulating since the first day of the week and become a pile by Friday. And the practices are left intimidated and overwhelmed with what they see.

Daily denial management is an effective tool to manage denials in a more methodical manner. By definition it means getting a sense of what your denials are on a daily basis and equipping yourself the tools required to tackle the denials. Its relatively simple to practice, doesn’t take a lot of time and the outcomes are significant.

Here’s how you can implement this process in your practice:

1. Know the nature of denials. Which are the top denials for your practice? Which denials are more frequent than the other.

2. Create relevant “buckets” for the denials eg. Denials requiring medical records, incorrect coding, coverage dependent (eligibility, benefits, authorizations), deliberate denials by payors, those requiring appeals… you get the point.

3. Before the end on each day get a load of all the denials you have come across that day. If you do the billing yourself, then you can easily make out the denials from the EOBs or ask your billing department to get the report for you – its fairly easy.

4. Categorize the denials into the buckets that you have created.

5. List down the action requirements for each bucket.

Once you employ this practice you’ll see a pattern emerging for the denials. You will notice that most denials are consequences of something that you had missed. Go back and fix the missing, not only for that particular claim or denial but for the process, for e.g. there has to be a 59 modifier associated with 45380 – Colonoscopy with Biopsy when billing with 45385 – Polypectomy – Polyp removal – make a note of such coding updates and use them every time you submit same procedures.

When the process is fixed the denials will reduce. With every fix the process becomes stronger. As little as an hour can save you dollars and time.

Tag: Denial Management

3 Tips that guarantee success in managing Reimbursement Cuts

Reduce denials in five easy steps