Stop Denials in Their Tracks: Get Paid the First Time by Health Care Insurers, #2

Kathy McCoy, MBA August 23rd, 2012

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Expert Betsy Nicoletti advised in this complimentary Kareo webinar that by setting up a process to measure, quantify and fix the reasons for denials, practices can significantly improve their collections and cash flow—and their bottom line.

There’s no denying it: Denials are the bane of every practice’s profit-and-loss statement. But the good news is: By setting up a process to measure, quantify and fix the reasons for denials, practices can significantly improve their collections and cash flow—and their bottom line.

That was the message during Betsy Nicoletti’s recent Kareo-sponsored webinar entitled Stop Denials in Their Tracks: Get Paid the First Time by Health Care Insurers. Betsy is a well-respected practice management and medical billing expert, as well as founder of Codapedia.com. During her webinar, she provided a blueprint for minimizing the number of denials on the claims you submit, so you can take back the dollars you are leaving in payers’ coffers. Our first blog on her webinar offered ways to track denials and the reasons for them, along with some of the more common pitfalls that trigger denials. This last blog on the webinar will recap Betsy’s strategies for getting claims clean and complete enough to pass even the most exacting claims scrutiny.

Betsy acknowledges that sometimes, it takes some detective work to determine the reason for denials. That is certainly the case with coding errors. A modifier might be added to the wrong CPT code, or modifier 59 may be added to a procedure that cannot be unbundled. Diagnostic tests may be denied because the provider failed to establish medical necessity by linking it to the correct diagnosis code. Or just as common, the test was performed more frequently than the payor allows. The solutions to coding errors are often found hidden in plain sight, in editorial comments of the CPT book. Betsy suggests you start there and read complete descriptions of codes along with the editorial comments. For complex coding issues, specialty societies can often provide information and supporting documentation and some will even field a few coding questions for free for their members.

Other errors are more easily prevented and rectified, such as misspelling the patient’s name or entering wrong demographic information; failing to verify insurance and benefits prior to the appointment; or authorization errors, such as not obtaining  pre-authorization or having the referral for services. Not filing claims on a timely basis can automatically trigger a denial, too. For all of these errors, Betsy recommends a “zero tolerance” policy that holds staff accountable for fulfilling the basics of claims submission.

Expert Betsy Nicoletti advised how to measure, manage and reduce denials in this complimentary Kareo webinar

Betsy strongly advises that medical billers fix claims before they are denied by checking clearinghouse reports daily. The reports will flag pre-adjudication errors so that they can be corrected before they are sent.  If your practice management system supports it, use technology to help you manage claims preparation and submission. Many systems can perform batch verification of eligibility or benefits, including patients’ deductible amounts, patient due amounts by benefit type, and more. Coding programs can check for bundling or diagnosis code congruence, if modifiers are allowed and if so, which ones. Take advantage of functionality such as claims estimators and electronic remittance advice and payments. To learn more about how Kareo’s powerful suite of tools helps streamlinine your medical billing and collections, visit Kareo.com

Finally, establish policies and procedures that set clear expectations for staff. They should include full registration at the time of the appointment; verification of eligibility and benefits; and authorizations prior to the appointment. Coding policies may include double-checking denials by another set of eyes before re-submitting them.

By tracking, measuring, researching and fixing the reasons for denials, practices can give themselves a much needed raise. To hear more on other practice management or medical billing issues that impact or enhance profitability, view our archived webinars to find more topics of interest to you. If you would like to be put on our notification list for upcoming informative webinars such as this one, sign up now.

Learn additional ways to improve your practice revenue: Register now for our next informational webinar, Finish Strong: Make 2012 Your Most Profitable Year! with widely respected consultant Karen Zupko.

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