Denial Management: Are You Doing Enough?

Denial Management: Are You Doing Enough?

 

LUTZ BUSINESS INSIGHTS

 

denial management: are you doing enough?

cathy bojanski, healthcare manager

 

“There’s tremendous pressure to reduce denials. According to CMS, 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected.”1

Are you doing all you can to identify, manage or prevent claim rejections and denials? Here are some helpful hints and suggestions that you can easily implement to make your office more efficient and accelerate your collections.

 

POST payments, and more importantly denials, daily (or as soon as possible); Have a process.

  • Are the payments correct per your payer contract?

 

MANAGE the reports – Do you have access and are you receiving the reports required?

  • There are reports from your vendor, the clearinghouse and finally the payers themselves to facilitate this process.
  • If a claim is rejected how long does it take to resubmit a rejected claim?
  • Does your system have built-in screening edits, pre-submission?
  • Who works these?
  • How often?

 

TRACK the types of denials – Are you doing this?

  • Categorize the denials
  • By payer, by code with description; Know your payor mix to prioritize
  • What actions are needed to correct the claim?
  • Educate and inform – Make this information available to all staff.  Chances are several staff members are dealing with the same denial issues.

 

RECOGNIZE trends

  • Ask the right questions of the billers and coders. Do you see this often?  Is this all payers or a specific payer denial?

 

FIX

  • System corrections – work with your vendor to identify and correct issues up-front, saving time and money
  • Corrected claims – simple corrections (CPT code/modifiers/units) by adjustment
  • Appeal – medical denials (NCD and LCDs)
  • Know the payer-specific time limits for submitting corrections/appeals
  • Process for tracking corrected claims and appeals to ensure they are processed and paid?

 

1 http://healthyhospital.changehealthcare.com/ten-steps-reduce-denials-win-appeals-improve-hospital-performance/

 

ABOUT THE AUTHOR

402.827.2366

cbojanski@lutz.us

CATHY BOJANSKI + HEALTHCARE MANAGER

Cathy Bojanski is a Healthcare Manager at Lutz with over 25 years of experience. Her primary responsibilities include preparation and review of Hospital and Clinic Chargemaster (CDM) reviews for healthcare clients, as well as assisting with coding and billing services.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Association for Rural Health Professional Coding, Member
  • Certified Billing Specialist

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13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

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CMS Survey & Certification Emergency Preparedness Initiative

CMS Survey & Certification Emergency Preparedness Initiative

 

LUTZ BUSINESS INSIGHTS

 

cms survey & certification emergency preparedness initiative

kirk delperdang, healthcare manager

 

Following the devastating experiences by health care facilities during Hurricanes Katrina and Rita, the Centers for Medicare & Medicaid Services (CMS) Survey and Certification (S&C) Group established a series of internal working groups, with representatives from the CMS Central and Regional Offices, to develop updated emergency preparedness policies and procedures that effectively address S&C essential functions. The recommendations from the working groups are being integrated into the larger CMS and HHS national plans to provide preparation guidance for S&C essential business functions.

The emergency preparedness rule for Medicare Participating Providers and Suppliers was published September 16, 2016, and the implementation date was November 15, 2017. It applies to all Hospitals, Long Term Care Facilities, Critical Access Hospitals, and Rural Health Clinics.

*Compliance is required for Medicare participation.

There are four core elements of the Emergency Preparedness Program and element of the plan must be reviewed and updated annually.

RISK ASSESSMENT AND PLANNING – All providers must develop an emergency plan using all hazards approach, and plan and identify in advance essential functions and who is responsible in a crisis.

POLICIES AND PROCEDURES – These are developed based on the plan (e.g. medical documentation, evacuation or shelter and place).

COMMUNICATION PLAN – Establish alternate means of communication, provide information to local authorities sharing medical information, and provide occupancy information and assistance to other facilities in the community.

TRAINING AND TESTING PROGRAM – Train staff and test the plan through drills.

NOTICE ON TRAINING & EXERCISES

If a facility activates their emergency plan due to a disaster, the facility is exempt from one full-scale/individual based exercise for that year. However, the secondary requirement for a table-top exercise or exercise of choice still applies. Facilities must demonstrate completion of two exercises per annual year.

HAVE YOU TESTED?

The testing requirements include:

Participation in a full-scale exercise that is community-based, or when a community-based exercise is not accessible, an individual, facility-based exercise.

AND

Conduct an additional exercise that may include, but is not limited to the following:

  • A second full-scale exercise that is individual, facility-based.
  • A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan.

IS THERE AN AFTER ACTION REPORT (AAR)? 

The AAR should document the exercise and next steps. Make it stand out with clear diagrams, lists of best practices, opportunities for improvement, and lists of resources. Make it readable and, most importantly, know where it is.

CMS wants you to “Demonstrate staff knowledge of emergency procedures.”

 

 

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Templates-Checklists.html

https://narhc.org/resources/rhc-rules-and-guidelines/#emergency

ABOUT THE AUTHOR

402.496.8800

kdelperdang@lutz.us

LINKEDIN

KIRK DELPERDANG + HEALTHCARE MANAGER

Kirk Delperdang is a Healthcare Manager at Lutz with over 25 years of experience. He provides accounting and consulting services to healthcare and related organizations.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association - Nebraska Chapter, Member
  • Nebraska Society of Certified Public Accountants, Member
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Northern Iowa, Cedar Falls, IA
COMMUNITY SERVICE
  • St. Vincent de Paul, Knights of Columbus, Member
  • Active in various youth sports leagues: Aldrich Elementary, Millard Athletic Association, Millard North Schools, Omaha FC, Skutt Catholic High School and YMCA

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We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Why Do a Chargemaster Review?

Why Do a Chargemaster Review?

 

LUTZ BUSINESS INSIGHTS

 

why do a chargemaster review?

paul baumert, healthcare consulting shareholder

 

How pricing is set for a healthcare organization can have a significant impact on its financial performance. If individual charge items in the chargemaster file contain errors, payment for services could be wrong or denials can occur. These are two critical reasons why it’s important to routinely review the chargemaster file.

The chargemaster file is a main component in any third party compliance review, since the healthcare organizations’ reimbursement originates from individual charge items. Ensuring accurate code descriptions and pricing for individual service items is paramount for price transparency. Below are additional reasons to conduct a chargemaster review:

  • Keep up-to-date CPT/HCPCS Codes
  • Correct Revenue Code assignment
  • General Ledger/Department assignment and mapping accuracy for proper cost report preparation
  • Remain compliant with billing and coding for services
  • Ensure accurate Charge Capture for services performed

Maintaining an accurate and compliant chargemaster file is an on-going process. Periodic internal and external comprehensive reviews are essential duties of the revenue cycle team. Additionally, to properly monitor and update a healthcare organizations chargemaster file, policies and procedures are critical to ensure on-going changes are made. This will help prevent errors in payment and compliance related issues that can arise with incorrect/outdated chargemaster files.

ABOUT THE AUTHOR

Paul Baumert

402.827.2315

pbaumert@lutz.us

LINKEDIN

PAUL BAUMERT + HEALTHCARE CONSULTING SHAREHOLDER 

Paul Baumert is a Consulting Shareholder at Lutz with over 20 years of experience in accounting and consulting for healthcare and nonprofit industries. He specializes in the areas of financial management support services and reimbursement analysis.

AFFILIATIONS AND CREDENTIALS
  • Nebraska Society of Certified Public Accountants, Member
  • American Institute of Certified Public Accountants, Member
  • Healthcare Financial Management Association, Member
  • Certified Public Accountant
  • Fellow of the Healthcare Financial Management Association
EDUCATIONAL BACKGROUND
  • BSBA, Creighton University, Omaha, NE
COMMUNITY SERVICE
  • Elkhorn Public School Foundation, President
  • Iowa Healthcare Financial Management Association, Past President
  • Nebraska Society of Certified Public Accountants Legislation Committee, Chairman

SIGN UP FOR OUR NEWSLETTERS!

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Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Cash Flow Problems? 5 Ways to Improve It

Cash Flow Problems? 5 Ways to Improve It

 

LUTZ BUSINESS INSIGHTS

 

cash flow problems? 5 ways to improve it

mike perry, client accounting services director

 

You can fix some of the problems your small business faces and move on. You change couriers or banks or suppliers if services and fees aren’t acceptable.

Cash flow is not one of these. It’s a constant battle, one that you will always have to be monitoring. Here are five steps you can take to make some headway.

Balance your receivables and payables

You value your customers—especially the long-term ones—but are you being too generous with them by having terms of 30 or 45 days while your suppliers expect payment in 15? Making those two sets of due dates match more closely should improve your bank account balances.

Of course, this will require some negotiating with your vendors and/or breaking some bad news to your customers. Consider offering your customers early payment discounts and applying finance charges to late remittances. Appeal to your long-time suppliers and see if you can stretch out those due dates.

Send and accept electronic payments

Pay your bills electronically wherever possible. This will allow you to pay right before the due date rather than sending a check 10 days ahead that may be cashed quickly. You might even consider paying with a business credit card that offers benefits you need, like cash back – as long as you always pay your bills in full.

Offer the same courtesy to your customers. Establish a merchant account so they can make bank or credit card payments. You are likely to get paid sooner.

Tighten up your inventory

Inventory levels that aren’t closely monitored and adjusted can be a drag on your cash flow. Stock too much of an item that’s not selling, and you have money tied up unnecessarily. Let yourself run short on popular items, and you’re losing sales. You need to have real-time inventory counts so you know ahead of time when to have a sale and when to order more items. This insight can also help you determine when it’s time to raise or lower prices.

Personalize your collection efforts

Email reminders are fine, but they’re rather impersonal and easily ignored. Customers who are seriously in arrears should get one or more of the following:

  • Statement with a handwritten note on it
  • Personal business letter sent via U.S. Mail
  • Phone call

Cash flow forecast

You need to know where your money is all the time – and where it might be in six months or a year. For that reason, you need at least two standard financial reports: Statement of Cash Flows and Cash Flow Forecast. These are difficult-to-impossible to assemble manually—even in Excel. And they’re hard to interpret.

Software and Expert help         

If these actions sound too complex and time-consuming, you’re probably not using accounting software like QuickBooks, which can help you with all five steps. We can get you set up with it; we can also provide you with a cash flow analysis. Contact us, and we’ll help you make a plan for dealing with this perpetual problem.

 

ABOUT THE AUTHOR

Mike Perry + Lutz Client Accounting Services in Nebraska

402.827.2087

mperry@lutz.us

LINKEDIN

MIKE PERRY + CLIENT ACCOUNTING SERVICES DIRECTOR

Mike Perry is a Client Accounting Services Director at Lutz with over 15 years of accounting experience. He focuses on providing business consulting, software implementation and training, accounting procedure assistance and outsourced accounting replacement consulting for closely held companies.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • American Institute of Certified Public Accountants, Member
  • Nebraska Society of Certified Public Accountants, Member
  • Intuit Certified ProAdvisor, QuickBooks Advanced
  • Certified Public Accountant
EDUCATIONAL BACKGROUND
  • BSBA in Accounting, University of Nebraska, Kearney, NE
COMMUNITY SERVICE
  • Community Bike Project Omaha, Past Treasurer
QUICKBOOKS PROADVISOR CERTIFICATIONS

Certified ProAdvisor - Online  Certified ProAdvisor - Advanced Desktop  Certified ProAdvisor - Enterprise

BILL.COM CERTIFICATIONS

Bill.com Guru Certification   

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

2019 Tax Return: Why You Should Prepare Early & How To Do It

2019 Tax Return: Why You Should Prepare Early & How To Do It

 

LUTZ BUSINESS INSIGHTS

 

2019 Tax return: why you should prepare early and how to do it

adam austin, tax manager

 

Filing your taxes isn’t always simple and enjoyable. For this reason, many people tend to put them off as long as possible. Unfortunately, delaying your tax preparation will only hurt you in the end.

Starting your tax prep early will help you stay organized, allow you to collect documents at a leisurely pace, find more deductions, and overall, save yourself and your accountant time and trouble.

An Initial Meeting in 2019

Start thinking about your 2019 taxes before 2019 ends. By December, you should meet with your accountant to talk about any financial changes you’ve experienced this year: income fluctuations, new deductions, outdated deductions and so on. This way, you’ll have a good sense of your tax liability and you can avoid being hit with unforeseen penalties or other negative surprises.

Tip: Early tax prep is especially important for those with significant income that’s not subject to withholding. Examples may include investments and income from a flow-through entity (partnership, S-Corporation, sole proprietorship).

Another benefit to early tax prep is getting a head start on your document collection. Your accountant can specify which forms, statements and itemized deduction materials to gather to facilitate preparing your return. You’ll then have a few unhurried months, not a few hectic days, to find them. Naturally, your stress level will go down when you are more prepared.

Tip: Early preparation also increases the odds of locating receipts and other records that can lead to more deductions!

File Early in 2020!

Once 2020 dawns, it’s wise to file that return as soon as you can. Get all of those documents you’ve been collecting to your accountant!

There are a few major advantages to submitting a tax return well before the April 15 deadline.

  1. You’ll get your refund sooner. The IRS and states can process it before the stampede of returns in March and April.
  2. You’ll know how much you owe earlier, and you’ll have more time to figure out when and how to make your tax payments. You and your accountant can discuss how much to pay upfront and how much, if any, to put on a credit card or set up on an installment plan.
  3. Your tax preparer will certainly be less busy in the winter than the spring. He or she will have more time to devote to you, and it’ll be easier to schedule appointments at your convenience.

Keep It Organized

When you file your taxes, a tax organizer can come in handy. What is a tax organizer you ask? It’s a lengthy checklist that you can find online or get from your accountant.

Make sure you fill out your organizer each year. Then, the following year, you can review every item from your prior tax return. Consequently, you’ll know which documents to have on hand.

Your organizer will supply your tax preparer with changes to your personal information, including changes to your address, dependents, or employment situation, as well as any major changes in your income or deductions. This list also includes an estimated tax payment timetable. It records the amount and timing of any tax payments you made to the IRS or states throughout the year.

The organizer will include summary sheets you can fill out. These statements outline your charitable contributions (both cash and non-cash), Schedule C business income and expenses, rental property income, farm income, and other detailed financial matters, particularly those with lots of receipts. Again, it greatly facilitates organization.

Another useful tool is something you probably already own: a file folder. Instead of sending your accountant each document as you find it or as they arrive in the mail, organize those sheets into a folder first and send to your accountant all at once. Your tax prep will be more efficient, and the odds of an accounting error will decrease. Additionally, you might keep digital copies of those forms in an online folder and send to your accountant electronically.

Tip: You’ll especially appreciate your folder if you’re ever audited. Everything will be ready for the IRS right away.

 

In summary, when you file your taxes early and begin tax prep even earlier, you and your hardworking accountant can enjoy a smoother experience. Your return will be more accurate, and you’ll get to spend your refund dollars sooner!

ABOUT THE AUTHOR

402.514.0019

aaustin@lutz.us

LINKEDIN

ADAM AUSTIN + TAX MANAGER

Adam Austin is a Tax Manager at Lutz with over nine years of tax and consulting experience. He is responsible for providing tax consulting and compliance services to clients with a focus on business income tax for a variety of industries and individual income tax.

AREAS OF FOCUS
  • Tax Planning & Consulting
  • Individual, Partnership, & Corporate Taxation
AFFILIATIONS AND CREDENTIALS
  • American Institute of Certified Public Accountants, Member
  • Nebraska Society of Certified Public Accountants, Member
  • Certified Public Accountant
EDUCATIONAL BACKGROUND
  • BSBA in Accounting and Finance, University of Nebraska, Lincoln, NE

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850