LUTZ BUSINESS INSIGHTS
denial management: are you doing enough?
“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.
- Ask the right questions of the billers and coders. Do you see this often? Is this all payers or a specific payer denial?
- 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 necessity 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?
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