Email not displaying correctly? View it in your browser. Issue #4 — Oct 27, 2010
AAPC ICD-10 Newsletter

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F R O M   T H E   F I E L D

Streamline Your Denials with One Simple Spreadsheet
By Dawn T. Landry, CPC — Lakeview, FL

We all know how important it is to work our denials in a timely manner. But do we analyze what these denials are telling us? Do we look for patterns in our denials? Every day it seems we open the mail, post our payments, then begin the tedious process of turning these denials back around for payment. We need a tool to be able to stop the denials from happening in the first place. Now, we all know that no matter what we do, the denials will still come; however, we can work smarter with them.

The tool is called a Denial Tracking Log and if you faithfully complete one for a two- to three-month period, problems will begin to jump out at you. Then you will be able to modify office or coding guidelines to decrease these denials. For example, if you have a lot of denials for no authorization, you can take this up to the front office and show them exactly how many denials you have received and then formulate a solution to eliminate these denials. If you find that Medicare is denying a procedure for invalid ICD-9-CM repeatedly, you can take the log to your billing dept, have them pull an LCD and find the problem and correct it.

The spreadsheet should be simple. List common denial reasons down the spreadsheet (for example, denied for no auth, pt coverage termed, invalid ICD-9-CM, needs notes …) and then list your top 10 insurance companies across the top. As you are working your denials, fill in the spreadsheet with tic marks. This should take only seconds of your time—it does not need to be fancy. After a few months, take a look at it and your top denials will pop out at you.

We should all be able to tell our providers what our top three denials for any given time are, and this simple tool will help you do that!

 

G O O D  T I P S

Don't Write off Unpaid Bills with a Deceased Patient - Tips on How to Collect Them
By Delly Parham, CPC, CLA — Sarasota, FL

How do you collect an unpaid account upon the death of a patient and keep your revenue cycle alive? Many of us might take the easy way out and write off accounts owed by a deceased patient instead of using simple collection procedures. A few simple tips have helped me increase the cash flow in a large lab.

  • Make sure that the patient (or estate), and not insurance, is responsible for the bill.
  • Subscribe to a publication in your locality which compiles records of deaths and decedent’s estates.
  • Send a letter requesting payment to the person named in your records as next of kin or to the person named in the estate records (executor or personal representative) to be responsible for the final bill.
  • If the bill is not paid and you determine there is an estate proceeding, file a claim for the balance owed with the estate of the deceased patient. It is important to know the principal residence of the patient. The court or your attorney can obtain a claim form for you. You must file the claim within 30 to 90 days; ascertain from the court the deadline for submitting a claim. File it within the proper timeframe!
  • The claim should be paid within a short period of time. In all cases, claims must be paid before the estate assets can be distributed to heirs. If the assets are not sufficient to pay all claims, you may receive a pro rata share.
  • Then and only then, write off the unpaid balance. REMEMBER, the claim must be filed within the time set by the court. Otherwise it will be lost forever!

 

F E A T U R E D   A R T I C L E

Best Practices When Researching Claim Denials
By Julie Pope, CPC-H, CPC-I, CMA (AAMA) — Louisville, Ky

A medical claim can be denied for various reasons. The most common reasons are:

  • Lack of medical necessity
  • Lack of pre-authorization
  • Erroneous patient demographic information
  • Erroneous provider data
  • Incorrect subscriber identification number
  • Invalid ICD-9-CM, CPT® and/or HCPCS Level II codes
  • Invalid place of service codes

How do you work smarter, not harder when it comes to managing your denied claims? Here are 10 tips:

  1. Track information monthly, quarterly, and annually. Prepare a spreadsheet documenting the following data:
    • Percentage of claims denied
    • Most common types of denials
    • Which payers denied claims most frequently and why
    • Net effect of denials on cash flow

In “From the Field,” a spreadsheet is described for you.

  1. Appoint well-trained employees in the distinctive position of denial management. When EOBs are interpreted incorrectly, there is the potential for loss of revenue through incorrect contractual write-offs on the patient’s account, oversight of an opportunity to appeal a denied charge, or improperly balance billing the patient.
  2. When the reason for the denied claim has been determined, timely action is required. Many payers have time limits on filing appeals. Sometimes the corrective action could simply be to call the payer. Be sure that the staff member calling knows the details of the reason for the denial, the medical necessity for the service(s) provided, and the original codes filed on the claim.
  3. If a phone call to the payer is unsuccessful, a written appeal letter may be necessary. Send this by certified or registered mail to ensure it is received by the payer. Be sure to attach any necessary documentation to support your appeal. Progress notes, operative reports, laboratory and/or test results are very helpful in substantiating your case.
  4. If after exhausting your appeal options, you do not attain a satisfactory outcome, you may contact your state insurance commissioner. Formal complaints against health insurance companies (with the exception of self-funded plans) can be filed with your state insurance commissioner. For additional information, visit the National Association of Insurance Commissioners (NAIC) at www.naic.org.
  5. If you need to submit a corrected claim because of incorrect demographic information, invalid identification numbers, place of service or ICD-9-CM, CPT® or HCPCS Level II codes, be sure to make the correction(s) and note on the claim "Corrected Claim," or send a letter with the claim stating what you corrected. Avoid resubmitting the claim without this information: It may get denied again as a "duplicate claim."
  6. Read and understand your managed care contracts. Be aware of each payer’s appeal process. Many contracts require the provider to request a review of denied claims in writing. Specifically examine the contract language that relates to the timeframe for seeking reconsideration by the payer, the documentation required, and the address and title of the person to whom to direct the appeal.
  7. Implement automated systems for obtaining, tracking and monitoring data. If possible use scanning devices for obtaining copies of insurance cards. This will help decrease data entry errors. Be sure to train staff properly on how to use the equipment and software programs.
  8. Monitor results and report positive financial impact to the staff and providers. This will help to motivate everyone to continue to work on preventing future denials.
  9. Clearly, the way to work smarter and get paid promptly is to submit a clean claim the first time. A clean claim is defined as “a claim free of any errors.” Double check claims, either manually or via your computer software, for any simple errors. Check for codes that are billed, but not supported by documentation, incorrect dates of service, missing provider or patient data, etc. Most electronic claims processing software and/or clearinghouses have the capability to perform these proofreading functions. This will allow corrections to be made before the claim is submitted to the third party payer.

FROM THE FIELD is thoughts and experiences from you the reader. If you have any tips, ideas, case studies or just anecdotes please submit them to us for future edtions.

In This Issue
Denials Spreadsheet
Deceased Patient Collection
Denial Best Practices

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