Clinical, Financial and Administrative Insights For Physicians

Denial Management Best Practices

Posted by Alok Prasad

Best Practices in Denial Management Challenges

If someone asked you to give away thousands of dollars annually for no reason, would you do it? Probably not, unless you’re a wealthy philanthropist.

Physician practices of all sizes that don’t pay attention to denied healthcare claims essentially relinquish revenue. Instead of performing the time-consuming process of figuring out why some claims are denied and how to appeal them, they leave a substantial amount of money untouched. Even though about two-thirds of all denied claims are recoverable, approximately 65% of them are never resubmitted.

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Denial Management Challenges Faced by Small Practices

Posted by Alok Prasad

Top 5 Denial Management Challenges Faced by Small Medical Practices

Despite rumblings about the decline of the number of small physician practices in the United States, they still comprise a substantial portion of the healthcare industry. In fact, the most recent Physician Practice Benchmark Survey from the American Medical Association (AMA) noted

that in practices with fewer than five doctors, about half were wholly owned by physicians. The largest percentage of U.S. medical practices includes practices with two to five physicians, and approximately 56.5% of doctors work in practices with under ten physicians.

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(Updated) Primer on Modifier -25? Use it but don't abuse it.

Posted by Suzanne Prasad

Modifier 25

When used appropriately, modifier -25 can enhance revenue for a physician practice. That’s because reporting this modifier allows physicians to bypass an Outpatient Code Editor (OCE) edit to receive additional payment. However, physicians must understand the rules regarding this modifier—and the documentation required to support it. No physician wants to discover after the fact—during an audit—that he or she must pay the money back.

Here are some facts about modifier -25 that can help physician practices maintain compliance.

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7 Remarkably Easy Tips to Prevent and Manage Claim Denials

Posted by Suzanne Prasad

‘Denial’ and ‘rejection’ are two words that no physician wants to hear. Yet, the unfortunate reality is that many physician practices lose money every day to claims that fail to meet payer requirements, Yvonne Dailey, CPC, CPC-I, CPB told attendees at the 24th annual HEALTHCON conference sponsored by the American Academy of Professional Coders. The conference, held in Orlando, Fla. last month, drew nearly 2,700 medical coding professionals.

During a presentation about denial management, Dailey spoke about how denials and rejections have only increased over time due to the increase in the number of carriers nationwide, each of which has its own nuances and rules for payment.

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Claim Denials - What You Need to Absolutely Know?

Posted by Alok Prasad

Tired of Tracking Claim Denials??

Physician practices lose thousands of dollars annually because of claim denials. However, what many practices don’t realize is that denials can be mitigated or even prevented altogether simply by establishing a denial management strategy. During times of decreased reimbursements, increased payer scrutiny, and the recent transition to ICD-10, no practice can afford to ignore denials any longer.

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Top 5 Claim Denials - Implementing Denial Management Strategy

Posted by Alok Prasad

5 Common Medical Practice Denials

Denial Management

5 Commonly Denied Procedures

Denials are an ugly reality that every physician practice must address. It’s not a question of whether practices will receive a denial—it’s a question of when and why.

RemitDATA—a company that provides comparative analytics data for the outpatient provider market—reported in September 2014 that these five procedure codes most frequently result in unexpected denials:

  • 99213 (outpatient doctor visit, level 3)
  • 99214 (outpatient doctor visit, level 4)
  • 36415 (routine blood capture)
  • 99232 (subsequent hospital care)
  • 97110 (therapeutic exercises)
The company uses a comprehensive electronic remittance database to analyze the most frequent reason codes for each of these denials. Consider the following reasons why these denials occur as well as tips to ensure compliance proactively Read More

Seven Ways Outsourcing Medical Billing Boosts Your Bottom Line

Posted by Alok Prasad

In a high-compliance environment, outsourcing medical billing functions seems like a loss of control for some medical practices. In reality, outsourcing claims billing with the right provider enhances physician control over billing processes. Outsourcing has also been shown to increase profits, productivity, and patient satisfaction.

Lower Staffing Costs

An obvious reason to outsource medical billing work is to reduce overhead costs for your small medical practice. Managing claims processes is a full-time job requiring at least one staff member, which means practices pay salaries for one or more people along with benefits and other associated expenses. In an outsourced environment, due to economies of scale, medical billing vendors are able to fold claims into existing resources and processes, providing the same functionality for a fraction of the cost.

Streamline Processes

A study of 5,000 physicians indicated 60 percent spent a total of one day a week on administrative functions. Paperwork encumbers small medical practices, reducing clinician's ability to treat patients. Outsourcing administrative tasks streamlines in-house processes and reduces tedious paperwork tasks.

Reducing Claim Errors

Relying on medical coding services from expert vendors decreases loss of revenue associated with claim denials. Medical billing vendors keep up with constant changes in medical billing requirements, making it possible for them to include proper modifiers and other coding on all claims. Proper coding and claim submission automatically drives up cash flow for your medical office.

Even in a perfect billing environment, denials happen for a variety of reasons. In an office setting, a denial costs you money because you pay staff extra time to find errors and resubmit claims. Most medical billing vendors charge a percent of paid claims, so you don't pay extra for work on denied or error claims.

Decrease Time to Payment

When billing is done in house, it often takes a secondary seat to other work. Medical office staff may divide time between claims billing and patient-centered duties such as reception, answering phones, and collecting information. That means claims could sit for days or weeks before being billed, and denials could take months to resolve.

When you outsource medical billing functions, the vendor's experts don't have to split their time. Instead, they can bill claims immediately and follow up with insurance claims in a timely manner, increasing the rate of cash flow for your practice.

Specialization Breeds Success

Healthcare providers appreciate the benefits of specialization in clinical applications. General practitioners don't attempt to treat their patients' serious cardiology issues, and doctors wouldn't ask reception staff to run an x-ray machine. The same need for specialization expands to the administrative functions of a medical practice. Outsourcing claims billing and denial management to specialists ensures the work is done by experts who make it a point to stay current on electronic claims requirements, billing and coding rules, and specific changes within payer organizations.

Increase Patient Satisfaction

By outsourcing medical billing work, you free in-house staff up to assist patients. Patients who are greeted, communicated with, and seen in a timely manner are more likely to return to a practice and refer others. Fast, accurate claims processing from an expert organization is another way to increase patient satisfaction.

Understand Financial Status

Medical billing vendors provide reports and statuses that let you assess financial health for your medical practice. Creating the same level of visibility and reporting in-house can be expensive and take time away from other necessary functions. Being able to understand your financial status, including the amount and number of claims pending in various statuses, lets you make smart choices about expansion, purchases, or hiring in your office.

Contact RevenueXL today to find out more about medical billing services and schedule a demo to see how our software and services can help your practice increase productivity and profitability.

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Use Proper CPT Modifiers to Reduce Claim Denials

Posted by Suzanne Prasad

CPT Modifiers

CPT modifiers let payers know something specific about a procedure, sometimes resulting in additional payment for the provider. Among other things, modifiers signal that additional work was required, that procedures were performed by multiple providers, procedures were performed more than once, or unusual events occurred during service. Successful use of these modifiers requires consistency and the support of documentation within the medical record.

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Medical Billing - 5 Insurance Eligibility Steps For Every Practice

Posted by Suzanne Prasad

How to Verify Insurance Eligibility?

EMR & Medical Billing Best Practices Series: #6

According to RemitData, two of the top five claim denial reasons for 2013 were insurance-coverage related. Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan in question. Putting a solid insurance verification process in place can reduce these types of denials in your practice, making medical billing practices more efficient and raising your overall bottom line.

Insurance should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Follow these five steps to reduce the chance your billing team deals with constant eligibility-based denials.


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ICD-10 Coding Could Create Cash Crunch in Physician Offices

Posted by Alok Prasad

On October 1, 2014, all health care providers will switch from ICD-9 coding to ICD-10 coding when they bill private insurance, Medicare and Medicaid . To understand how large this move is, there are only 20,000 ICD-9 codes while the number of codes in ICD-10 set is nearly 70,000.

Healthcare finance officials disagree on whether the new coding will increase or decrease initial denials. It is clear that when the October 2014 deadline comes, provider productivity will see an initial drop in due to denial of claims that will eventually drop off to similar levels existing today. However, denial management will become easier as the increased specificity of the ICD-10 classification system makes it easier to code correctly and also to correct denied claims. Nevertheless, one study estimates that small practices will suffer a decrease in productivity from $8,500 to $20,250, and medium practices will suffer productivity decreases of $72,649 to $166,649. Large practices can expect productivity losses from $736,487 to more than $1.5 million.

To succeed in making the transition to ICD-10 denial management as painless as possible, the process for claims denial management cannot wait even one day more.

Advantages to patient care and disease will be a derivative of ICD-10 coding because of its specificity, but many providers are viewing implementation just as everyone with a computer system fretted over the never seen Y2K disaster. If you are in this category, you should worry as time is running out.

How to Mitigate Losses From Implementing ICD-10

Awareness and preparation are the keys to mitigating losses from delayed and denied payments. Break the denial management process into smaller pieces so that no task is overwhelming. When your billing function is properly prepared in terms of people, processes, and technology the better prepared your practice will be in responding to changes that are coming.

  • Begin with people. The new coding will affect everyone in the practice, including physicians, nurses, and registration and appointment personnel and billing staff including coders. Existing now are curricula ready for deployment far in advance of the October 1, 2014 implementation date.
  • Begin planning for hiring your ICD-10 trained coders now. There will be more jobs than qualified coders, so hire now. The sooner you hire the sooner you have another resource to use in training your staff.
  • Medical practices with a strong claims denial management process in place are already learning the root causes of denials, determining gaps in your processes and are taking corrective action.
  • Make process changes now for ICD-coding denials that give you the ability to determine if a denial is related to ICD-10. Already, many codes cross over from ICD-9 to ICD-10. Denial crosswalks and other processes that address cross over coding before filing a claim can be a substantial help in lowering ICD-10 risk.
  • It is important that the practice knows which current tools and processes must change before the transition is finalized. Simple fixes go a long way towards reducing denials. Simple changes may include changing field length and alpha character acceptance. Changes that are more difficult require more data hooks for comprehensive financial and clinical analysis.
  • Dealing with ICD-10 implementation calls for thorough, trended reporting of financial metrics. From these reports, practices can learn details of ICD-10 coding denials, as well as resolve many of the conflicts that arise from mammoth changes in a reimbursement system.

The beauty of a claims denial management system is its ability to point out “hot spots” in your claims filing process. A sound claims denial management system looks at everything and reports to you quantitatively at where you have gone off-track. It may be wrong registration data – incorrect ID number or leaving out the gender. Or, insurance could deny a claim if it the ICD code is not specific enough.

RevenueXL is a company that works with medical practices ranging in size from solo providers to large group practices. We have solutions for claims denial management ranging from complete software solutions, workflow analysis and solutions for electronic medical records, medical billing, medical coding, coding audits, and denied claims management. Call RevenueXL now at 888-461-9998 to learn how we can help you prepare for ICD-10 implementation.

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