REVENUE CYCLE PRINCIPLES SERIES
|
|
- Julia Bell
- 8 years ago
- Views:
Transcription
1 REVENUE CYCLE PRINCIPLES SERIES Part 3 The Fundamentals of Producing Clean and Complete Claims Derek Morkel, President & CEO, GAFFEY Healthcare
2 REVENUE CYCLE PRINCIPLES SERIES Part 3: The Fundamentals of Producing Clean and Complete Claims A More Focused Approach to Reducing Denials Part One Recap The message of part one was simple our work is to collect cash in the most efficient manner possible. As complicated as it all is, revenue cycle work can be segmented in two focus areas on a daily basis: 1. Collect more cash 2. Collect cash more efficiently The two basic principles can then be broken down into three main areas of focus: 1. Clean claims 2. Bill efficiently 3. Collector productivity Part Two Recap Part two focused on matching your facility s resources both people and time to the key factors that improve clean claims and revenue cycle efficiency. Making sure that all business processes are well established and communicated regardless of the process is critical. Collecting receivables is no different. Billing efficiently and having superior collector productivity will be significantly enhanced if you get the first step 100% correct on a daily basis. Introduction The first two parts of our series focused on the broader aspects of why it is important to focus on clean and complete claims and the resources necessary to ensure success. Part three takes a step further to dig into the specific components of which processes produce both clean and complete claims. The end result of getting this right is not only better collections, but typically better net revenue, higher collections and greater efficiency. An examination of the most common reasons for claim denials almost always provides some insight into what needs to be fixed to correct the errors. Even though the reasons we discuss here come from national or regional analysis of claim denials, it is always useful to analyze your own hospitals denials (at least monthly) to make sure that you are addressing the root causes at your own facility. Page 1
3 Most common causes for claim denials Trailblazer Health Enterprises one of the largest Fiscal Intermediaries (FI) analyzed claim denials from its database and published (June 2010) the following listing of principal causes for hospital claims denials. 1. Duplicate claim/service 2. Non-covered service 3. Medicare Advantage plan 4. National Correct Coding Initiative (NCCI) 5. Screening/routine services 6. Patient supplies 7. Beneficiary eligibility 8. Medicare Secondary Payer (MSP) 9. Provider eligibility 10. Hospice As a comparison, an analysis of several studies of physician claim denials produced the following list of the top 10 reasons. Top ten reasons for physician claim denials are the following: 11. Incorrect or missing ICD-9 diagnosis 12. Incorrect or missing modifiers 13. Duplicate claim 14. Additional information needed to process the claim 15. Billed amount is correct 16. Incorrect/missing CPT procedure codes 17. Physician s name and/or NPI number is missing or incorrect 18. Incorrect or missing place of service code 19. Incorrect or missing quantity, multiples or services 20. Services are unbundled There are a number of different studies regarding the cost to rebill and rework a claim denial most of them identify the amount around $25-$35 per account. Whichever number you use, it is clear that it is very inefficient and expensive to rework a claim. Both of the listings also include a number of categories that would cost the provider additional reimbursement even if the claim is paid the first time. A grouping of the reasons by functional area is extremely revealing and proves the point that an intense focus on the front end is critical to efficiency. The physician breakdown is slightly different as significantly more work is done by the billing function to produce a clean claim. Category Hospital Physician Admitting 6 2 Coding 1 3 Billing 1 3 Charge Capture 1 1 Administrative/System Setup 1 1 Page 2
4 Focus areas to improve clean claim rates & reduce denials Admitting QA The claims process actually begins with preadmission and then the admission process. Admitting staff not only need to be trained to make sure the right forms are filled out, but they also need to be able to verify that the patient s insurance information is correct, collect any co-payments due and check that any necessary pre-authorization forms from physicians and insurances are on file. 70% of the data required to complete the billing process comes from admitting. As we can see from the denial analysis, 60% of the denials in a hospital can be directly attributed to admitting errors. With each error potentially costing $25-$35 to correct on the back end, it makes sense to have a robust QA function for admitting. 100% of all the claims should be checked for the denial reasons listed above and your own analysis of your facility s denials. The QA should also be done by someone who is knowledgeable about admitting. Quite often the task is relegated to a lower level employee and/or only done sporadically as an afterthought. Tip: It is sometimes good to rotate this function between your admitting staff so they can see the errors being made throughout the department. It is also good to periodically have them sit with the billers to see what the result of an error is in the billing cycle. On the back end, you need a clear understanding of where your denials are coming from in terms of both the reason for them and the payer involved. That means creating some type of denial management database. This will ensure that the QA process is always evolving and matching the current needs of your facility. Charge Capture & Coding Correctly documenting the services and procedures a patient receives during an inpatient stay or even in a visit to the emergency room i.e. charge capture is a vitally important step in the process. For example, if a clinician documents a medication the patient receives (by infusion) but forgets to record how the medication was delivered, the insurer won t pay for the delivery, just the medication. It s unlikely that the medication miraculously made it into the blood stream; thus, the fact still remains that the provider will not be paid correctly for the claim. Implant charges are another typical culprit. Not only can missing implant charges cause potential denials, but they can also result in lost reimbursement up to $40,000 for certain cardiac and neurological/spinal implants. Potentially a very costly error. Charge capture should be a daily discipline that is the responsibility of many different departments in the hospital. Much like the admitting QA function a review/reconciliation should be part of each department s responsibilities. If this is completed each day correctly by every department, then the amount of charge capture errors should be greatly reduced. Page 3
5 Technology Much of what we have discussed so far can be accomplished by improving the originating processes and having a review function. However, it is important to note that there are many applications available today that can aid in the review and control process and make it even more comprehensive. Almost all of the parts of the revenue cycle discussed within this series are prone to human error even the review/qa process. Technology applications like CDM maintenance software, Charge Capture, Medical Necessity, Bill Scrubbers, etc. should be an integral part of the front end of any hospital s revenue cycle. It is not possible for any human being to remember or review all the line items of a hospital CDM it can only be done properly by software. The same can be said for Charge Capture and Bill Scrubbing. These applications can scan thousands of claims in seconds looking for potential errors. It is for this reason that these should be integrated into the setup, review and QA functions at the hospital. Eliminating one $40,000 error provides an attractive ROI for all the applications listed above. Conclusion On the front end, a variety of seemingly unrelated steps in the process including payer contract negotiations, admitting, charge capture and billing all contribute to the potential success or failure of getting a claim paid correctly and on time. A process that focuses on the components discussed within this document will result in a much higher clean claims rate. 1. Clean claim focus by all departments not just admitting 2. Robust review/qa function including use of technology applications 3. Continuous feedback monitoring of QA results and denials keeps the focus on current issues By promoting a culture of cross-departmental cooperation that attacks the breakdowns in various steps in the claims life cycle, denial rates will begin to fall, collector productivity will increase and CASH will improve. For more information, contact us today at or sales@gaffeyhealth.com GAFFEY Healthcare hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this information is not intended to be definitive. GAFFEY Healthcare and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof. Recipients of this information should consult original source materials and qualified healthcare regulatory counsel for specific guidance in healthcare reimbursement and regulatory matters. Page 4
REVENUE CYCLE PRINCIPLES SERIES
REVENUE CYCLE PRINCIPLES SERIES Part 8 Reducing the Cost to Collect Derek Morkel, President & CEO, GAFFEY Healthcare Introduction REVENUE CYCLE BASICS SERIES Part 8: Reducing the Cost to Collect Using
More informationUtilization Review and Denial Management
September 2014 Clinical Resource Management Series Part 3 of 10 Utilization Review and Denial Management Part 3 in our Clinical Resource Management (CRM) series is focused on utilization review and denial
More informationCARE MANAGEMENT SERIES Part 6 Developing a Staffing Model That Works
CARE MANAGEMENT SERIES Part 6 Developing a Staffing Model That Works We will get to staffing but let s start by reviewing core functions. Care Management As we have discussed previously, Care Management
More informationReducing the Cost to Collect Using cloud-based workflow tools to reduce collection costs by up to 50%
Revenue Cycle Basics Series Part Eight Reducing the Cost to Collect Using cloud-based workflow tools to reduce collection costs by up to 50% Derek Morkel, President & CEO, HealthTech Solutions Group Revenue
More informationKeeping the Reimbursement Train on Track
EXECUTIVE BRIEFING Keeping the Reimbursement Train on Track By Kelley Blair MA, vice president at Craneware Professional Services and Linda Corley, MBA, CPC, corporate compliance officer, Dell Services
More informationReporting of Devices and Leads When a Credit is Received
Reporting of Devices and Leads When a Credit is Received Cardiac Rhythm Management and Electrophysiology Updated January 2014 Medicare Reporting Requirements For Full or Partial Credits of Devices and
More informationHOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE
Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals
More informationOptimizing Coding in Primary Care, Part 1
Learning Objectives Optimizing Coding in Primary Care, Part 1 Understand the financial impact of poor coding Correct common primary care coding errors Bill Dacey, MHA, MBA, CPC The Dacey Group, Inc. Palm
More informationRevenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
More informationEffective Central Business Office (CBO) Management The 5 Best Practice Pillars. Derek Morkel, President & CEO, GAFFEY Healthcare
Effective Central Business Office (CBO) Management The 5 Best Practice Pillars Derek Morkel, President & CEO, GAFFEY Healthcare A 5-15% cost reduction & performance improvement is possible using the 5
More informationPatient Billing. Questions/ Answers. Assistance Programs
Patient Billing Questions/ Answers Assistance Programs Table of Contents Patient billing: an introduction... 1 Patient financial responsibilities... 2 Our promise to you... 3 Frequently asked questions...
More informationContracting and Clean Claims: Billing Techniques for Success!
Contracting and Clean Claims: Billing Techniques for Success! Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation
More informationRevenue Cycle. An operational overview and some ideas of how to negotiate the complex roads ahead. HFMA ROAD SHOW SUTTER CENTER FOR HEALTH PROFESSIONS
HFMA ROAD SHOW SUTTER CENTER FOR HEALTH PROFESSIONS Presented by: Steve Thompson and the PFS Revenue Cycle Committee January 7, 2008 Revenue Cycle An operational overview and some ideas of how to negotiate
More informationHow to Prepare a Winning RAC Appeal
How to Prepare a Winning RAC Appeal Craneware InSight Consulting Copyright 2011, CRANEWARE INSIGHT. All rights reserved. www.cranewareinsight.com p.1 Introduction Introductions Karen Bowden, RHIA, Senior
More informationTHE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH
THE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH OPTIMA November 7, 2013 TABLE OF CONTENTS Executive Summary... 1 Process Overview... 4 Areas of Testing... 5 Site Visit Selection...
More informationRegulatory Compliance Policy No. COMP-RCC 4.07 Title:
I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest
More informationREVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC
REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT WHAT S THE BIG DEAL? Productivity = Efficiency + Effectiveness How much input (cost) is needed
More informationInpatient Common Denials
Advanced Billing: Inpatient & Outpatient Services 1 Inpatient Common Denials Introduction Purpose This module will familiarize participants with an overview of the most common denial messages providers
More informationLocal Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)
Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article
More informationRevenue Cycle Management
Revenue Cycle Management Manage and Improve Your Results with Origin RCM Financial pressures are escalating for both healthcare providers and patients. In this challenging climate, a wellmanaged revenue
More informationNetPractice Practice Management System. Increase Profitability Improve Patient Care Improve Patient Satisfaction Easy to Use
NetPractice Practice Management System Increase Profitability Improve Patient Care Improve Patient Satisfaction Easy to Use The Ultimate Practice Management Tool Tailored for Orthopaedics Stryker NetPractice
More informationThe Power of Metrics Part Two. By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice
The Power of Metrics Part Two By Rob Borchert, CPAM July 2009 The Power of Metrics Part Two By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice July 2009 THE POWER OF METRICS PART
More informationManaging the Hospital Charge Description Master (CDM)
The Business of Hospital Charge Capture Like most businesses, hospitals must be able to catalog, appropriately charge, and reconcile all services provided to its customers. In a hospital s case, however,
More informationERA Manager Implementation. Andrea Frost
ERA Manager Implementation Andrea Frost Agenda Populate ERA Data Utility ERA Manager Demo Setting up a customer for ERA Manager Training your customer on ERA Manager ERA Manager and Task Manager Integration
More informationOur Lady of Lourdes Health Care Services, Inc. and Affiliates Administrative and General Policy POLICY NUMBER: AS0019CCP. PAGE NUMBER: 1 of 9
Administrative and General Policy PAGE NUMBER: 1 of 9 ACCOUNTABILITY: OBJECTIVES: POLICY: President and Chief Executive Officer RELATION TO MISSION: Our Lady of Lourdes, a Catholic Health System a member
More informationRejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle
Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results
More informationClinical Research Management Webinar Series: How to Process Medicare Advantage Claims for Research Billing
Clinical Research Management Webinar Series: How to Process Medicare Advantage Claims for Research Billing Wednesday, September 19, 2012 12:00 p.m. - 1:00 p.m. CT About Our Speakers Allecia A. Harley Director,
More informationCommon Medicare Billing Mistakes Systems and protocols necessary to help prevent and overpayment Best practices in resolving an overpayment
Bill J. Ulrich, President / CEO Consolidated Billing Services Inc. Pat Newberry, Director of Clinical Education AIS Inc. Common Medicare Billing Mistakes Systems and protocols necessary to help prevent
More informationBCBSKS Billing Guidelines. For. Home Health Agencies
BCBSKS Billing Guidelines For Home Health Agencies BCBSKS IPM BCBSKS Home Health Agency Manual -1 TABLE OF CONTENTS I. Overview II. General Guidelines III. Case Management IV. Home Care Benefits V. Covered
More informationWHITE PAPER. Payment Integrity Trends: What s A Code Worth. A White Paper by Equian
WHITE PAPER Payment Integrity Trends: What s A Code Worth A White Paper by Equian June 2014 To install or not install a pre-payment code edit, that is the question. Not all standard coding rules and edits
More informationBasics of the Healthcare Professional s Revenue Cycle
Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through
More informationFederally Qualified Health Center Billing (100)
1. As a federally qualified health center (FQHC) can we bill for a license medical social worker? The core practitioner must be a licensed or certified clinical social worker (CSW) in your state. Unless
More informationPROTECTING CASH FLOW DURING THE ICD-10 TRANSITION
PROTECTING CASH FLOW DURING THE ICD-10 TRANSITION The transition to ICD-10 will broadly impact every medical practice s revenue cycle. Practices must examine their revenue cycle management processes now
More informationAmong the many challenges facing health care
The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential
More informationWhat Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs
What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze
More informationCompensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
More informationUnderstanding Your Role in Maximizing Revenue in a FQHC
Understanding Your Role in Maximizing Revenue in a FQHC Cynthia M Patterson President N Charleston SC 29420-1093 Firstchoice.practicesolutions@gmail.com P: (843) 597-8437 F: (888) 697-8923 Have systems
More informationThe Power of Business Intelligence in the Revenue Cycle
The Power of Business Intelligence in the Revenue Cycle Increasing Cash Flow with Actionable Information John Garcia August 4, 2011 Table of Contents Revenue Cycle Challenges... 3 The Goal of Business
More informationHow to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice
How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and
More informationThe Power of Revenue Management
The Power of Revenue Management Presented By Judy Capko Capko & Company www.capko.com The Power of Revenue Management 6/13/07 1 About the Speaker The Power of Revenue Management 6/13/07 2 The Speaker:
More informationYour Speaker. The Elements of the Revenue Cycle MANAGING THE HOME HEALTH REVENUE CYCLE
MANAGING THE HOME HEALTH REVENUE CYCLE Hoosier Home Care & Hospice Conference May 11, 2010 3:15 p.m. 4:45 p.m. Your Speaker Terry Cichon, CPA FR&R Healthcare Consulting, Inc. Frost, Ruttenberg & Rothblatt,
More informationThe following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.
The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a
More informationICD-10: Prepare, Implement, and Train
ICD-10: Prepare, Implement, and Train Source Medical Solutions, Inc. October 2013 For more information, please visit www.sourcemed.net or call 866-687-2300 1 Executive Summary There are numerous documents
More informationRevenue Cycle Management Practice
Revenue Cycle Management Practice W h i t e p a p e r By William Malm, ND, RN Practice Director, Revenue Cycle Management, HCPro, Inc. Recovery audit contractors Recovery Audit Contractors Strategic planning
More informationConsumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan
ConneCtiCut insurance DePARtMent Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan What consumers need to know about seeking approval for behavioral
More informationRevenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps
Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected
More informationProvider Adjustment, Time limit & Medicare Override Job Aid
Provider Adjustment, Time limit & Medicare Override Job Aid Contents Overview... 1 Medicaid Resolution Inquiry Form... 1 Medicare Overrides... 3 Time Limit Overrides... 3 Adjusting a Claim through the
More informationZimmer Payer Coverage Approval Process Guide
Zimmer Payer Coverage Approval Process Guide Market Access You ve Got Questions. We ve Got Answers. INSURANCE VERIFICATION PROCESS ELIGIBILITY AND BENEFITS VERIFICATION Understanding and verifying a patient
More informationCompensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
More informationConsumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan
CONNECTICUT INSURANCE DEPARTMENT Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan What consumers need to know about seeking approval for behavioral
More informationUnpaid Claims Management
Unpaid Claims Management National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com AGENDA Introduction Clean
More informationGlossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits
Account Number/Client Code Adjudication ANSI Assignment of Benefits Billing Provider/Pay-to-Provider Billing Service Business Associate Agreement Clean Claim Clearinghouse CLIA Number (Clinical Laboratory
More informationImproved Revenue Cycle Management. Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting
Improved Revenue Cycle Management Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting Optum Businesses (Formerly Known as Ingenix) One of the largest health information, technology and consulting
More information* Dignity Health. Success
* Dignity Health. Tools for Success Table of Contents ICD 10 Overview Physician Practice Checklist Financial Planning for ICD 10 ICD 10 Education for Physicians ICD 10 Education for Staff ICD 10 Impacts
More informationOptum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.
Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,
More informationUnlisted Procedure Codes Frequently Asked Questions
Unlisted Procedure Codes Frequently Asked Questions Use of an unlisted code is common when a physician performs a new procedure or utilizes new technology when no other CPT code adequately describes the
More informationCOM Compliance Policy No. 3
COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION
More informationWELLCARE CLAIM PAYMENT POLICIES
WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the
More informationThis information is current as of the training dates.
Welcome to this training on Billing Basics for Washington State Local Health Jurisdictions. This training will help you understand basic principles and processes needed for billing private insurance. This
More informationRevenue Cycle Management Optimized
rreturnsttopbooth2014final.indd 1 6/13/2014 9:32:34 AM Revenue Cycle Management Optimized Powerful technology combined with expert knowledge and resources Innovative Revenue Cycle Management brought to
More informationMAXIMIZING COLLECTIONS
MAXIMIZING COLLECTIONS Janice Rutter, Director, Support Services, Merge Healthcare Jon Neal, Ph.D., Vice President, InstaMed Mark Snow, Vice President, RevSpring (formerly PSC Info Group) Tracy Sanders,
More informationProvider Revenue Cycle Management (RCM) and Proposed Solutions
Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare is denying an increasing number of claims, because providers are not identifying the correct primary payer prior
More informationMeaningful Use Is Not the Finish Line
Meaningful Use Is Not the Finish Line A White Paper From Health Language CALL 720.940.2900 EMAIL info@healthlanguage.com ONLINE www.healthlanguage.com Meaningful Use Is Not the Finish Line Improved information
More informationCHAPTER 5 SERVICE DESCRIPTIONS. Inpatient Hospital Psychiatric Services. Service Coverage
CHAPTER 5 SERVICE DESCRIPTIONS Inpatient Hospital Psychiatric Services Service Coverage Inpatient psychiatric care involves skilled psychiatric services in a hospital setting. The care delivered includes
More informationRTE Strategies for Revenue Cycle Management
Tutorials, M. Davis Research Note 18 February 2003 RTE Strategies for Revenue Cycle Management By 2005, care delivery organizations will have to adopt realtime enterprise strategies to survive the continued
More informationTop 50 Billing Error Reason Codes With Common Resolutions (09-12)
Top 50 Billing Error Reason Codes With Common Resolutions (09-12) On the following table you will find the top 50 Error Reason Codes with Common Resolutions for denied claims at Virginia Medicaid. This
More information10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer
Common Issues in Practice Management Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer cpmresults.com Industry Trends cpmresults.com Patient Responsibility Patients are now responsible
More informationPatient Billing & Insurance Information Q&A
Patient Billing Requirements Patient Billing & Insurance Information Q&A At your first visit our office you are required to bring your insurance card and driver s license. Our office will copy this information
More informationThe Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare
The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare The Future of Revenue Cycle - Big Data and Business Intelligence. You
More informationAvoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments
Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments January 30, 2013 Carmen Elliott, MS American Physical Therapy Association Senior Director, Payment & Practice
More informationCertification Pathways. Additional Business Office Certifications
Certification Pathways PAC: Patient Access Certification PAS: Patient Access Specialist Cert Annual Patient Access Recertification Billing Prerequisite BC: Billing Certification BSC: PFS/Billing Specialist
More informationSection 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
More informationINSURANCE BILLING & COLLECTIONS PROCEDURES
INSURANCE BILLING & COLLECTIONS PROCEDURES I. PURPOSE: To establish logical, consistent methods of billing and collections follow-up for Insurance balances to ensure that all staff members possess a good
More informationAnthem Centers of Medical Excellence (CME) Transplant Network. CONTRACT OPERATIONS MANUAL for Transplant Program
Anthem Centers of Medical Excellence (CME) Transplant Network CONTRACT OPERATIONS MANUAL for Transplant Program A supplemental document to the Anthem Blue Cross Facility Operations Manual TABLE OF CONTENTS
More informationBilling an NP's Service Under a Physician's Provider Number
660 N Central Expressway, Ste 240 Plano, TX 75074 469-246-4500 (Local) 800-880-7900 (Toll-free) FAX: 972-233-1215 info@odellsearch.com Selection from: Billing For Nurse Practitioner Services -- Update
More informationGone are the days when healthy
Five Common Coding Mistakes That Are Costing You Fix these problems to increase your bottom line. GREG CLARKE Emily Hill, PA-C Gone are the days when healthy third-party reimbursements meant practices
More informationPremera Blue Cross Medicare Advantage Provider Reference Manual
Premera Blue Cross Medicare Advantage Provider Reference Manual Introduction to Premera Blue Cross Medicare Advantage Plans Premera Blue Cross offers Medicare Advantage (MA) plans in King, Pierce, Snohomish,
More informationTop Performing PFS Sustaining Revenue Cycle Excellence. Greg West COO, Healthcare Resource Group
Top Performing PFS Sustaining Revenue Cycle Excellence Greg West COO, Healthcare Resource Group Competition target Why so few super bowl repeats Free agents turnover Rule changes laws and regs and industry
More informationStatus Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.
Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons
More informationClaims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H.
H.2 At a Glance H.4 Submission Guidelines H.9 Claims Documentation H.17 Codes and Modifiers H.22 Reimbursement H.25 Denials and Appeals At a Glance pledges to provide accurate and efficient claims processing.
More informationRevenue Integrity Strategies
Agenda Discuss the key activities performed, risks and typical deficiencies that exist, and various process improvement strategies within the following revenue cycle components: Patient Access Utilization
More informationCapacity Management: Patient Throughput and Case Management Improvement. February 25, 2015
Capacity Management: Patient Throughput and Case Management Improvement February 25, 2015 Agenda Introduction Impetus for Change Approach to Improving Case and Capacity Management Client Case Study Key
More informationFAQs on Billing for Health and Behavior Services
FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare
More informationCertified Access Manager (CAM) Study Guide
Certified Access Manager (CAM) Study Guide Revised 08/2015 Table of Contents I. NCAHAM.. II. Registration Basics Forms MPI Co-pay See Glossary Coinsurance See Glossary Deductible See Glossary Out of Pocket
More informationMEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE
DEPAR ARTMENT OF HEALTH AND HUMAN SERVICES Form Approved OMB No. 0938-0600 MEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE The Credit Balance Report is required under the authority of sections 1815(a),
More informationWEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.
HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:
More informationCLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format
Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department
More informationGetting Paid for Hospice Physician Services: Covered Activities and Roles
NHPCO has contracted with physician-billing expert, Acevedo Consulting Inc., to develop a range of resources to help members navigate the recent and forthcoming changes in physician billing under the federal
More informationHow To Get A Health Care Plan
Your financial well-being Everyone needs to plan ahead for Medicare Having a thorough understanding of how Medicare works and the choices you need to make about its coverage is an essential part of retirement
More informationHow To File A Claim Electronically
Revenue Cycle Management: Tips & Tools 2010 Annual Educational Seminar March 10, 2010 Presented By: Cindy Tipton, Coding & Compliance Director cindy_tipton@med3000.com What is the Revenue Cycle or Life
More informationCollections. Proven Strategies for Collecting Long-Term Care Accounts Receivable. Laura McDonnell
Collections 12 3,, Proven Strategies for Collecting Long-Term Care Accounts Receivable Laura McDonnell Contents About the author.................................. vi Introduction.....................................
More informationOptimize Healthcare Facility Revenue in minimum time. Billing /Coding/ Patient Management
TALISMAN SOLUTIONS Optimize Healthcare Facility Revenue in minimum time Billing /Coding/ Patient Management We put together a team of healthcare, financial and management experts to identify ways to optimize
More informationPREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014
PREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014 Diane Taylor, BSN, RN Selman-Holman & Associates LLC, Senior Associate Selman-Holman & Associates, LLC Diane Taylor, BSN,
More informationRevenue Cycle Management
ELIGIBILITY AND VERIFICATION Revenue Cycle Management Are you or your staff tired of waiting on the phone or jumping from website to website to verify patients insurance eligibility? Being able to verify
More informationHospice Widespread edits
Hospice Widespread edits Befriend this foe to prevent claim denials Beth Noyce, RN, BSJMC, HCS-D D, COS-C C Clinical Educator & QA Specialist and Dana Walling, RN, COS-C Director of Nursing, Branch Manager
More informationCHAPTER 17 CREDIT AND COLLECTION
CHAPTER 17 CREDIT AND COLLECTION 17101. Credit and Collection Section 17102. Purpose 17103. Policy 17104. Procedures NOTE: Rule making authority cited for the formulation of regulations for the Credit
More informationMolina Healthcare of Washington, Inc. CLAIMS
CLAIMS As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your reference:
More informationLesson Objectives Welcome to Lesson 14: Claims and Appeals After this lesson, you should be able to:
Lesson Objectives Welcome to Lesson 14: Claims and Appeals After this lesson, you should be able to: Explain who may file claims and where they submit them Describe how to begin to resolve a claim issue
More informationPresentation title here
Presentation Provider toolbox title here Sylvia Strickland, MBA, Provider Reimbursement Presentation title here Bridgette Ampey, CPC, Code Review Jorri Smith, Network Innovation & Education priorityhealth.com
More information