Urology Coding Alert

Share your top denial reasons with office staff and watch future denials disappear If you're not a watchdog for your practice's reasons for denial, you run the risk of overlooking big denial trends that equal major revenue loss.

Effective denial management is one of the biggest keys to controlling your accounts receivable, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. Because reasons for denial can change as frequently as the weather, it takes a focused coding and billing staff to stay on top of them.

Take control: Many billing experts recommend that you focus your denial management process by keeping a running list of your top-10 denial reasons. This list can serve as your guide to systematically address and fix the causes for denials in your office.

Use these six expert tips to compile the information you need for your top-10 list: 1. Update your list every month. Denial management is an ongoing process, so the top-10 denials one month may not be the same next month. In fact, you may find a problem and then fix it, and then you may see it slowly return. That could be due to new physicians joining your practice, new billing software, coders receiving conflicting information from insurers, or many other factors. Therefore, monthly reports are a must. 2. Focus on total and partial denials. Sometimes insurers will deny a claim and not pay any portion of your charges, but you should also pay close attention to the reasons why some claims come back partially paid or underpaid.

If the insurer discounts your charges excessively, the payer might have taken a higher percentage discount than your contract allows. Or, the payer may have downgraded your E/M or procedure claim (for example, from CPT 99214 to CPT 99213 ). 3. Put EOBs on a pedestal. Everyone in your back office can speculate about why they believe the insurer denied your urologist's claim, but only the explanation of benefits provides the carrier's ultimate reason. Make sure the coders who read your EOBs do more than enter charges. They should analyze your EOBs to accurately understand the reasons for denial and partial payment.

Sometimes the EOB will reveal an easy-to-correct problem. For instance, a typographical error on your part caused your software to accidentally cut off part of your urologist's UPIN on your claim form, so the insurer denied your charges. Other times, you'll have to investigate further to find the cause of the claim denial. 4. Call about unpaid claims at 30 days past due. You should run a report every month that lists all claims 30 or more days past due on which you've seen no activity in the last month.

Run the report based [...]