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Preventing Claim Rejections

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Preventing Claim Rejections: 3 Ways to Increase

Revenue

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Preventing Claim Rejections: 3 Ways to Increase Revenue

If the world was perfect, at the finish of every revenue cycle management process (RCM) there would have been a 0% rate of claim denials and 100% rate of payment of the claims. This world is assuredly, imperfect, therefore, all of this is unachievable. There are however, many foolproof ways the RCM processes can be improved for smooth processing by identifying the issues that may present themselves preliminary to them occurring.

Looking at the occurrences of claim denials and rejections by the American Academy of Family Physicians (AAFP) report the average for the claim rejections can be said to be 5-10%. Claim denials and rejections can be proven to be the most complex and complicated of issues that arise in the healthcare system. Usually, claim denial and rejections or delays can be due to short and minor mistakes that are unnoticeable and unavoidable such as minute coding errors and billing errors. However, the main question could be- “How much loss does a healthcare organization face in revenues due to this?”; answer to this question can be provided in the Change Healthcare report that was published in 2017. It said that the true cost is $31.51 for the rejected claims.

There are many significant ways by which healthcare providers can prevent claim rejections, the first being:

Prevention

Prevention can be ensured by making sure no errors are made in the bills, and by carefully checking the codes for any mistakes. This helps prevent facing any claim rejection or delays as dealing with the problems beforehand rather than solving the problems later ensures reduced cost to collect later on.

Automation

Automation as known, claim management is still done manually by the average rate of 35%. Opting for automation would not only save time but also money making sure that the claims at the backend are cleaner and that the administrative costs at the front end are significantly decreased.

Integration

Integration is also a way by which we can reduce claim rejections. More synchronized the claims management and more streamlined they are-more is it guaranteed for a simple and an easy way to access the data for real-time analytics. This as a result, presumably prevents medical coding errors.

AltuMED understand and applies all this, our PracticeFit optimizes the whole claim management system with synchronized ease increasing revenues significantly. Contact us for more info.

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Benefits of eStatements

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Benefits of eStatements 

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How can Medical Practices benefit from introducing eStatements/ePayments?

Having a cost effective, intuitive and supportive Billing advocate is essential for a Medical Practice to survive in today’s fierce marketplace. Patient Consumerism have increased, educating patients about benefits they should seek after. Automation and advanced technological solutions to the services patient avail i.e. like taking loans, paying utility bills, vehicles purchase payment etc have made everything easily available online. This need, to have all the information easily available have pushed Medical Practices to raise their standards and offer their services online for their patients as well.

Studies show that patient prefer Practices that provide them with online information access including their appointment schedules, their outstanding payments details, their claim statements, their medical history etc. This extends to giving them access to eStatements/epayments.

We at AltuMED, through a controlled case study, realized that when Medical Practices allowed their patients with easy payments options i.e. epayments and provided them with clear payment expected of them via estatements, their receivables increased reducing their AR days significantly. More so, paper bills/statement are expensive and inefficient, not just increasing the cost associated with (postage, paper, printing and labor) but also time. Medical Practices are known to issue statements, then reminders, it takes days, weeks or even months to finally collect the payment.

Paperless billing is the new norm and with smooth implementation Practices/patients prefer this method over the conventional one. It makes it easier for patients to understand what is expected of them, make payments, reducing the time and costs associated with paper billing. If collections can be made within hours than why not to take the hassle out of patient billing by implementing paperless method (eStatements).

AltuMED specializes in making the Billing process easy for its clients, allowing access to estatements is therefore an integral part in the bundle of billing services we offer. Leave us a message to find out more.

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Benefits of a Value-Based Care Model

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Benefits of a Value-Based Care Model

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Increasingly medical providers are shifting towards Value-based care (VBC) model as health industry is continuously evolving. It has come out as a possible replacement of Fee-for-service traditional model based on quantity than quality. Some healthcare providers are hesitant for this change as they are not certain about the outcomes and how it will affect their productivity

In comparison to fee-for-service, value-based care model reward providers for the quality of the care they deliver to patients which is measured by health results and not the quantity of services performed to just raise financial returns. The motivating force of VBC model is to give value through quality and patient engagement than volume.

In basic terms, implementation of Value-based care (VBC) model means quality of care than quantity of care at lower cost to both the parties. Patients will be no longer concerned about how much they will be charged for each service separately and health care providers will focus more on effective and favorable ways to provide care. It’s an innovative way to reduce health costs and improve patient health.

This model is cost effective to patients and providers both, as saving the money by systematizing processes and coordinated care lessen repetition of services or tests, by building associations with drug companies, reducing readmissions, emergency visits and unnecessary admission procedures, benefits programs for employees to increase their productivity, preventing diseases by detailed discussions etc. Patients recover more quickly and as a result less doctor’s visits, test, procedures and prescription and providers can make higher value by providing care at each event will be rewarded with Value-based care model.

Value-based care model focused on proactive, team oriented approach of sharing patient information so that care services are structured and coordinated to study the outcomes easily. As we live in a digital world with amazing reach to massive information which is being used to provide more improved healthcare experience and reduced medical cost. Digital solutions consist of both hardware and software solutions and services helps to promote wellbeing and aid fast and low-cost communications.

Digital Care

Tools helps to better understand patient’s condition and treatment plans. As digital solutions are available in every field of life so patients expect from providers to make sure of the same. Such tools make it easy for patients to connect easily, make online appointments, access to estatements, online payments and health records. Digital tools play vital role in smoothly implementing the Value-based care (VBC) model by studying data, finding gaps in care and reach out to patients at the earliest.

Wearable technology

Tools like smart watches, smart eye wears, applications, fitness tracker devices provides data that helps practitioners to easily share information, diagnose issue, observe health progress and comes to intervene when necessary. Such devices are helping patients to check vitals, activity progress and helps patients to stay encouraged in their routine life. Health care provider can make more informed care decisions by using this additional data coming from these smaller and easily accessible technologies.

Telemedicine tools

Are very important for those who lead busy lives and can’t seek required care through other means. Telemedicine has also been significant to the value-based care model. This tool allows provider to practice of caring for patients by using electronic devices when they are not actually present with each other. It eliminates excess medical travel for both patient and provider. Providers can practice care for more patients in less time with no additional stress. Physicians can see extra patients without the need to employ additional staff or increase office space thus, resulting in more revenues. It’s very convenient, time saving and money saving tool.

AltuMED is a Certified MIPS registry and understand the importance of Value Based Care Service. Contact us to learn more.

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Post Pandemic Protocols

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Post Pandemic Protocols for Clinics and

Healthcare Providers

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Post-Pandemic Protocols for HealthCare Businesses

COVID-19 Pandemic challenged our healthcare systems in ways no one imagined before. The restriction on unnecessary physical check ups and the demand of more virtual, touch free medical appointments have increased the need to rely on advanced technological set ups. For businesses that were not using such technologies the pandemic caused major issues finally resulting in complete shutdown. Now the next question for all businesses is, what the lasting changes will be in terms of clinic operations and patient care?

Era of Telemedicine and Telehealth

It is estimated that about 11% of visits were conducted using telemedicine platform before COVID 19 Pandemic. In many countries telemedicine though was rising but was not getting the success it promised. Patients preferred physical appointments and face-to-face check-ups. But then after majority businesses including healthcare providers had to lock down to prevent the spread of COVID 19, telemedicine visits increased to 46% in mere months. Now 70 – 80% of healthcare appointment are nothing but telemedicine visits. The Centers for Medicare and Medicaid Services (CMS) approved more than 80 new services to be done through telemedicine and telehealth platforms, and healthcare consultancy McKinsey estimates that as much as $250 billion in medical services may become virtual in the coming years. But after being forced to adopt the technology, both patients and providers say they like it. Among providers, 57% say they view it more favorably than they did pre-pandemic, and 64% feel more comfortable using telemedicine.

Patients prefer Clinics with Right Technologies

Clinics and providers have always been dragging their feet on the technology side of things, but consumers were increasingly demanding more technology, transparency, and convenience. That’s likely to continue and accelerate in the coming months and years, and providers who embrace the right technology will be better positioned to attract new patients to their practice.

Patient Consumerism have changed and patients now are looking for:

  1. Online Appointment Scheduling.
  2. Simple, Easy and Intuitive patient portals where they can access all their health information (lab results, appointments, medical history, visit notes) in a single place, and share it with other providers.
  3. Telemedicine visits whenever appropriate to eliminate wasted time and hassles for things like driving to a clinic, parking, and sitting in a waiting room.
  4. Patient-provider direct messaging to ask simple clinical or billing questions.
  5. Online check-in to reduce paperwork and cut down on wait times for each visit.
  6. Electronic billing notifications and online bill pay options.

Cloud-Based Systems is the future

On many fronts especially operational, these pandemic shutdowns highlighted a critical flaw in traditional clinic systems: the need to have providers and staff in office at all times relying on server-based software to access important patient data and provide care. Many clinics across globe were mandated to close with no physical access, which severely limited some providers’ ability to continue providing care even if you had access to telemedicine services.

Cloud-based systems provide secure access to providers and staff from any web-based device. If your current system is server-based, it’s time to switch to a cloud-based practice management system, EHR, and medical billing system.

Upgrade your Systems with AltuMED

Contact AltuMED to learn about all our cloud-based software solutions for small and independent medical practices and let us help you learn how to get the right technology to set you up for success in the future.

A Glimpse of Benefits

  • Maximize Time
  • Increase Patient in-flow
  • Streamline Processes
  • Increase Revenue
  • Reduce Redundancy

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HIPAA Compliance Proposed

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HIPAA Compliance Proposed Changes

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Mitigate Compliance Discrepancies and Maintain Revenue

Maintaining data integrity is one of the foremost concerns of medical practices. A data breach or other such violation of HIPAA regulations results in huge financial penalties, permanent brand defamation and, worst of all, loss of patients trust in your practice. AltuMED understand the seriousness of this requirement and is HIPAA compliant. Not only will we maintain all aspects of your RCM processes in compliance with HIPAA security regulations but will advise on making your practice, a HIPAA complaint entity too. The data we obtain while working with our clients is processed with keeping the compliance requirement under check. Each of our client is made to sign the HIPAA agreement thus mitigating any discrepancy. In order to keep true on our promise, we keep firm eye on the industry changes in this regard.

Changes Proposed to the HIPAA Privacy Rules

The Department of Health and Human Services (HHS) has proposed changes to the HIPAA Privacy Rules. The purpose of these changes is to support individuals’ engagement in their care, remove barriers to coordinated care, and reduce regulatory burdens on the health care industry.

“Our proposed changes to the HIPAA Privacy Rule will break down barriers that have stood in the way of commonsense care coordination and value-based arrangements for far too long,” said HHS Secretary Alex Azar. “As part of our broader efforts to reform regulations that impede care coordination, these proposed reforms will reduce burdens on providers and empower patients and their families to secure better health.

Among the features of the proposed changes are:

  • Greater family and caregiver involvement in the care of individuals experiencing emergencies or health crises.
  • Enhance flexibilities for disclosures in emergency or threatening circumstances, such as the opioid and COVID-19 public health emergencies

In addition to enhancing patient access to health information the proposed rule will reduce the burden on physicians when sharing information with other care providers. These changes are intended to enhance co-ordination of care and allow care givers to develop new ways to innovate.

Some of the more interesting features of the proposed rule that will have a direct impact on providers are:

  • Shortening covered entities’ required response time to no later than 15 calendar days (from the current 30 days) with the opportunity for an extension of no more than 15 calendar days (from the current 30-day extension).
  • Reducing the identity verification burden on individuals exercising their access rights.
  • Requiring covered health care providers and health plans to respond to certain records requests received from other covered health care providers and health plans when directed by individuals pursuant to the right of access.
  • Specifying when electronic PHI (ePHI) must be provided to the individual at no charge
  • Clarifying the scope of covered entities’ abilities to disclose PHI to social services agencies, community-based organizations, home, and community-based service (HCBS) providers, and other similar third parties that provide health-related services, to facilitate coordination of care and case management for individuals.
  • Replacing the privacy standard that permits covered entities to make certain uses and disclosures of PHI based on their “professional judgment” with a standard permitting such uses or disclosures based on a covered entity’s good faith belief that the use or disclosure is in the best interests of the individual. The proposed standard is more permissive in that it would presume a covered entity’s good faith, but this presumption could be overcome with evidence of bad faith
  • Expanding the ability of covered entities to disclose PHI to avert a threat to health or safety when a harm is “serious and reasonably foreseeable,” instead of the current stricter standard which requires a “serious and imminent” threat to health or safety.
  • Eliminating the requirement to obtain an individual’s written acknowledgment of receipt of a direct treatment provider’s Notice of Privacy Practices (NPP).
  • Requiring covered entities to post estimated fee schedules on their websites for access and for disclosures with an individual’s valid authorization6 and, upon request, provide individualized estimates of fees for an individual’s request for copies of PHI, and itemized bills for completed requests.

This is only a proposed change but there are many aspects that are expected to make it into the final rule. As with any proposed change, you should not take any action at this time, but it is important that you be aware of these changes and be ready when the final rule is published.

AltuMED can assist you in:

Enhancing Profits

Non-compliance costs more than twice the cost of maintaining or meeting compliance requirements. The average cost for organizations that experience non-compliance problems is $14.82 million, a 45% increase from 2011. Proactively handling such requirement is made foremost priority at AltuMED. Understanding the dire HIPAA regulations and maintaining them since last 10 years of practice without any hiccups enables us to maintain smooth running of operations in this ever evolving RCM healthcare landscape, enhancing revenue inflows and mitigating losses.

Data Managing Practices

AltuMED Billing Software is built as per HIPAA regulations therefore cannot be hacked by outside. Moreover, patient data being processed in the system is coded and kept secure. Every team member using it, is made to sign the HIPAA agreement, undertaking the data security clause with severity. AltuMED understand that to maintain compliance, teams need to integrate, respect and understand each other roles i.e. a finance member need to be in liaison with a person from clinical side to completely maintain the requirement. AltuMED therefore offers respective trainings to meet this gap.

Building Patient Trust

AltuMED through its technologically advanced systems allow practices to maintains clear and open communications with each of their patients through portals, this transparency instills trust on their part and allow them comfort to maintain business with your practice

Helping you attain the “HIPAA Compliant” Stature

AltuMED is HIPAA compliant and partnering with us to cater to your RCM processes will allow you a stress free practice where you can focus on giving 100% to your patients. Our team of experts will not just handle your processes as per compliance requirement but will also strive to make your practice attain the “HIPAA compliant” stature. We take you through the requirements step wise and will be monitoring any fall through proactively, taking timely actions to lessen any harm to your practice in terms of time, trust, resources or revenue. We strictly maintain compliance requirements and therefore are capable of ensuring that you maintain it too with all your processes and systems.

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Medical Billing Vs Outsourcing

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Inhouse Medical Billing Vs Outsourcing

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Inhouse Medical Billing Vs Outsourcing

Isn’t Medical billing one of the most time and effort consuming task, exhausting your resources, compelling you into performing frustrating tasks and diverting your attention from your main purpose i.e., patient’s wellbeing. More so because you need to focus on your practice, for smooth operations you need:

  • An accountant taking care of your financials,
  • A lawyer or team of lawyers keeping you up with the legal implications of the healthcare industry laws,
  • An industrial expert keeping you up to date with all the ever-changing medical billing procedures,
  • An IT technician keeping your infrastructure in topnotch working condition (laptops etc)
  • An assistant entering all the patient’s data/demographics as well as updating and completing required incomplete insurance information, required to submit patients billables/claims,
  • An expert who can communicate with the insurance and help you fix the denials and reduce AR days – on the same page with you regarding their requirements.

You get the idea? Think about the expenses this will incur on your practice. More so ever wondered why your denial rate doesn’t decrease or why a huge chunk of your revenue gets stuck and lost in the whole reimbursement process?

Opting for Outsourcing your Medical Billing Process enables:

AltuMED along with providing a real time, integrated and data driven solution to all your medical billing needs, works on improving your practice by helping you focus on care quality and the one thing that matters most — making patients healthier. We are HIPPA Compliant and a certified MIPS registry. Our expert makes your practice growth their priority by working with you in building your brand score, training and coaching you regarding your service gaps and advising you on practicing quality service. We understand the current health care codes and standards and are here to assist your practice accordingly.AltuMED strives with keeping you in compliance!

Fast Revenue Recovery:

On average, a dedicated billing company will send claims more thoroughly, reliably, and quickly than an in-house billing team. This means a higher percentage will be paid at a higher amount.

Easy and Efficient Recordkeeping:

Another significant and concrete benefit to outsourcing is the ease of record keeping and filing. Many practices experience difficulties when it comes to organizing all of their files, whether it is financial records or requisition forms. Throw more complex things like file digitization in, and you can start to have more serious problems.

Reduced Office Operational and Management Costs:

Another general benefit that can expect you when you outsource is that your office management becomes much easier. With outsourced medical billing, you reap the following benefits:

  • Fewer people need to be accounted for
  • Less payroll data has to be process
  • Less space and technology has to be taken care of
  • Few individual personalities need to be accounted for during interdepartmental proceedings

Here is how we at AltuMED can help!

AltuMED is here to make all this go away. AltuMED takes you onboard, optimizing your billing and administrative processes as per the latest CMS standards, more over you need not worry about compliance issues. Our services and software’s are all HIPPA complaint.

AltuMED allows you a hassle free digital medical billing service which caters to not just your billables but the whole revenue process starting from patient appointment scheduling to claim processing, payments and follow-up. Moreover, our other support services e.g. MIPS consulting, credentialing, billing audit, medical coding etc makes us a comprehensive package having a complete hold on the changing industry with a proactive approach.

Our Quality control parameters strive to maintain service gaps analyzing and improving workflow on the go. Our experts conduct random billing audits, keeping a track on your claim’s submission, denial and reversal data. AltuMED builds its stake on data driven parameters. Our KPIs include clean claim submission tactics. We believe in continuous improvement making sure that we aid your billing and managerial processes in an applaud worthy way. Our struggle to lower your AR days to 120 or below, in itself is a reflection of how we operate as a business. Let us share our RCM expertise and assist you in making your practice an outstanding one!

AltuMED helps in making your practice cost effective, efficient, transparent with a constant effort to reduce denials to 2.4% leaving your attention 100% to what matter the most – Your patients!

Here is the list of Services AltuMED offers:

Managed Medical Billing:

  • Patient Scheduling & Registration
  • Medical Coding
  • Denial & Appeal Management
  • Insurance Eligibility Verification
  • Claim Creation and Transmission
  • Account Receivable Management
  • Pre-Authorization Services
  • Payment Posting
  • Patient Follow UP

Here is how we at AltuMED can help!

AltuMED is here to make all this go away. AltuMED takes you onboard, optimizing your billing and administrative processes as per the latest CMS standards, more over you need not worry about compliance issues. Our services and software’s are all HIPPA complaint.

AltuMED allows you a hassle free digital medical billing service which caters to not just your billables but the whole revenue process starting from patient appointment scheduling to claim processing, payments and follow-up. Moreover, our other support services e.g. MIPS consulting, credentialing, billing audit, medical coding etc makes us a comprehensive package having a complete hold on the changing industry with a proactive approach.

Our Quality control parameters strive to maintain service gaps analyzing and improving workflow on the go. Our experts conduct random billing audits, keeping a track on your claim’s submission, denial and reversal data. AltuMED builds its stake on data driven parameters. Our KPIs include clean claim submission tactics. We believe in continuous improvement making sure that we aid your billing and managerial processes in an applaud worthy way. Our struggle to lower your AR days to 120 or below, in itself is a reflection of how we operate as a business. Let us share our RCM expertise and assist you in making your practice an outstanding one!

AltuMED helps in making your practice cost effective, efficient, transparent with a constant effort to reduce denials to 2.4% leaving your attention 100% to what matter the most – Your patients!

Here is the list of Services AltuMED offers:

Practice Management BPO Services

  • Patient scheduling
  • Data entry
  • Financial reconciliation
  • Eligibility and Pre Authorization
  • Practice Growth & Digital Marketing
  • Payer and Patient Follow up

MIPS Consulting:

  • End to End MIPS Management
  • Score Improving Consulting
  • Data Submission to CMS
  • Training and Coaching

Credentialing and Enrollment:

  • Financial reconciliation
  • Credentialing and Contracting
  • Revalidation/Re-credentialing
  • Contract Negotiation
  • State License Renewal
  • State License Renewal
  • CAQH Maintenance
  • NPPES Enumeration
  • Insurance Portal Creation
  • EDI/ERA, EFT Setup

Medial and HCC Coding:

  • Financial reconciliation
  • Eligibility and Pre Authorization
  • Practice Growth & Digital Marketing
  • Payer and Patient Follow up
  • HCC medical coding HCPCS, ICD-9 and ICD-10 coding including ICD-10-CM, ICD-10-AM, ICD-9-CM and CPT-4 medical coding
  • Payer specific coding services
  • Chart Audits and Code Review

Practice Management BPO Services

  • Patient scheduling
  • Data entry
  • Eligibility and Pre Authorization,
  • Payer and Patient Follow up,
  • Practice Growth and Digital Marketing
  • Financial reconciliation

Practice Growth and Digital Marketing

  • Custom website design and development,
  • Search Engine Optimization,
  • Local SEO
  • Social Media Management,
  • Reputation Management,
  • Digital Marketing Campaigns,
  • Content Marketing.

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How to Reduce Denials

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How To Reduce Denials

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What percentage of your claims are denied yearly? How do you cater to the revenue losses? Are you too always looking for improvements that can minimize claim denials, boosting up your RCM process and reducing AR days?

In an analysis conducted in 2019 by CMS 18% of in-network claims were denied by issuers, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. It was also found that appeal for denied claims is rarely made, and when it is, issuers typically uphold their original decision. MGMA states 25% of all claims not paid are never followed up on. This problematic picture results in heavy revenue plunges and thus negatively impacts the RCM process.

Patient Claims are usually denied due to number of causes:

1.     Coordination of Benefit Issues (COB)

2.     Incomplete or No Patient Insurance Validation

3.     Incomplete or incompatible diagnosis coding

4.     Upcoding or mis-coding of procedures

5.     Mis-Management of Multiple Claims

Practices are often dedicated to minimizing lost reimbursements and denials. AltuMED ensures as well as validates the insurance eligibility details of a patient from the time they request your service. Our employees verify patient insurance details as well as pre-validate whether the required treatment will be covered by their insurance or not. More so AltuMED software comes with pre-fed ICDs and CTPs assisting physicians fast and error free data entry regarding the diagnosis as well as the procedures performed.

Denials can be avoided:·        

  • Eligibility check before claims submission·        
  • Prior authorization before claim submission·        
  • Proper collection of co-pay and calculation

Here are five steps to lower your denial rate and implement proactive strategies to ensure smooth cash flow.

1. Know your current denial rate. To calculate your current denial rate, add the total dollar amount of claims denied by payers within a given period, and divide that amount by the total dollar amount of claims submitted within the given period. For example, look at a three-month period. If your total dollar amount of claims denied within this period is $10,000—and your total dollar amount of claims submitted is $100,000—then your denial rate is 10%.Calculate your denial rate according to payer, reason for denial, provider, specialty, and location (if your practice includes more than one location).

2. Identify the major reasons for your denials. These reasons will vary by specialty and by practice. Start by compiling your claim adjustment reason codes. Though these codes may be somewhat cryptic as well as inconsistent across payers, they at least provide a foundation on which you can build a denial management strategy. Map these codes to more actionable descriptors so you can dig into your data at a more granular level and identify the root cause of the problem.

For example, consider categorizing denials according to these common reasons:

  • Claim not submitted within timely filing guidelines·        
  • Demographic errors (e.g., wrong spelling of the patient’s name or wrong date of birth)·        
  • Duplicate claim·        
  • Eligibility expired·        
  • Global charges were billed when only the professional or technical component should have been billed·        
  • Incorrect insurer address·        
  • Incorrect modifier·        

  • Invalid procedure and/or diagnosis code·
  • Lack of medical necessity·
  • No referral/authorization·
  • No supporting documentation·
  • Payer requires additional information from the patient·
  • Provider not permitted to see the patient under the plan·
  • Service not covered·
  • Wrong insurer billed

3. Hire a revenue cycle manager or certified medical coder. This individual can help track denials and improve your chances of submitting error-free claims. More specifically, he or she can:·        

  • Serve as a resource to clarify code combinations, definitions of modifiers, documentation requirements, and more·        
  • Validate codes that the physician chooses in the EHR·        
  • Note discrepancies between procedures documented and supplies ordered but not billed·        
  • Find missed charges based on progress note documentation.

4. Create a multi-disciplinary denial team. Be sure to include the practice manager, a representative from registration, a coder and/or biller, and at least one physician who is willing to serve as a champion of the denial management effort. Team goals should include the following:·        

  • Collect data regarding denials. How are denials identified? Verify your ability to extract this data from your practice management system, or secure a bolt-on denial reporting product.      
  • Review data to identify trends. Can the practice use automation to route denied claims directly to specific work lists? For example, route all coding-related denials directly to the coder·        
  • Create a standardized workflow for denials. This should include a step-by-step action plan for each type of denial. Who will handle each type of denial, and how?

5. Focus on staff education. Many practices benefit from staff education on the following topics:·        

  • Accurate data entry. Collecting accurate and complete demographic and insurance information on the front-end is critical. One of the most common denials occurs when a patient’s health insurance expires and either the patient or the practice (or both) are unaware. In other cases, practices may check eligibility when an appointment is made, but coverage is dropped before the actual visit occurs. Real-time eligibility tools that provide information about coverage, deductibles, copayments, and contractual fees for specific services and procedures are helpful.      
  • Policies and procedures for insurance coverage and eligibility (e.g., payer-specific requirements regarding appropriate ICD-10 codes to use with certain CPT/HCPCS codes). Consider designating one person to receive and review all newsletters and updates from payers. This person can then disseminate important information to the rest of the team.       
  • Documentation requirements for ICD-10 specificity. Depending on your specialty, ICD-10 codes may require more specific documentation regarding laterality, anatomical location, and more.
  • Frequency/global rules for specific procedures. This should include a discussion of modifier usage.
  • Advanced Beneficiary Notices. Education should include how to fill out forms properly and what patients need to know at the time of service.  
  • Understanding your denials helps shed light on specific areas for improvement. By identifying these areas, your practice can take proactive steps to improve processes and mitigate risk going forward.

If you are looking for ways to improve you medical billing contact AltuMED – A Smart RCM Specialist.

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Stay Compliant, Stay Ahead

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Stay Compliant, Stay Ahead

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Stay Compliant, Stay Ahead

Compliance is a dangerous word that can restrict your revenue inflows if not taken seriously. Healthcare compliance regulations are ever changing and therefore demands a thorough command on the requirements by being prepared and forward. AltuMED is well versed with the healthcare RCM industry and is familiar with the way the CMS operates, our team of experts know just what to keep in check, to stay relevant and well informed regarding the change in the healthcare regulations.

Serving the RCM industry from last 10 years has given us expert know-how on what a practice requires to take off in terms of business and how to stay competitive without being side tracked by such obligations.

Quality Service is The Key

AltuMED along with providing a real time, integrated and data driven solution to all your medical billing needs, works on improving your practice by helping you focus on care quality and the one thing that matters most — making patients healthier. We are HIPPA Compliant and a certified MIPS registry. Our expert makes your practice growth their priority by working with you in building your brand score, training and coaching you regarding your service gaps and advising you on practicing quality service. We understand the current health care codes and standards and are here to assist your practice accordingly.AltuMED strives with keeping you in compliance!

AltuMED believes in evolving with the industry taking on a proactive approach towards the upcoming changes in healthcare standards. AltuMED aims to improve on your reimbursements and mitigate penalties. With AltuMED

Master the Quality Service Practice:

AltuMED’s portfolio of solutions are all formed keeping the regulatory requirements in check so that your practice can grow without any complexity

Prioritize your Patients:

AltuMED takes care of all your financial, operational and administrative tasks leaving you to focus on your Patients

Maximize on Revenue inflows:

AltuMED keeps you well informed regarding the changing CMS regulations, making sure that you stay in compliance and no cases are lost due to any such discrepancy.