Four Strategies for Improved Denials Management

Managing claim denials is important for the ongoing success of healthcare organizations. Establishing an effective denial management process can significantly increase your revenue cycle and reduce your number of future denials. In 2012 National Health Insurer Report Card exposes that insurers deny up to 5% of claims on the first compliance. Even the best-performing medical practices have denials of 5%, according to the 2012 Performance and Practices of Effective Medical Groups report.  To avoid losing money on the table, you are required taking steps to improve your medical billing process and reduce your denials.

Follow these four strategies to denial management—identify, manage, monitor and avoid.

Retain your Denial Management Process

Losing track of denied claims is like leaving money from your back pocket. Once, it's frustrating. But as it keeps happening, you'll have a serious problem on your hands, as those denied claims have a method of piling up over time. If you don't have an organized system in place to retain track of your denials, you won't even know when they're missing in the first place.

Determine Patient Eligibility

Train your staff to gather pertinent info about every patient’s health insurance coverage and benefits eligibility. They need to remember to ask the patient about variations in insurance coverage, too. Your practice management system should have the ability to verify eligibility and advantages.

Reduce Coding Errors

Coding errors will likely lead to more denials. Take positive steps to reduce coding errors. Identify services usually provided by your practice, and then seek expert advice on how to code those services. Train your doctors how to document properly and select the correct codes. Use info technology (i.e., code correct software) to confirm the accuracy of the codes, either when the codes are selected.

Determine Medical Necessity

To avoid this frustrating condition, use software that edits charges for coverage determinations. Gather policies regarding medical need from all your insurers. Set your Electronic Health Record to alert you about services that have been deemed not medically essential or that have special requirements for establishing medical need. To appeal denials based on medical need, submit detailed documentation about the patient’s visit, as well as any current medical literature supporting the efficacy of the facility. Contact us to reduce your medical claim denials and thereby increase your income.

Are you interested in improving the denials management for your medical billing and coding practices? Try Precision7 for improving your ROI.

Processing a Medical Billing Claim

Healthcare system in the United States is a trillion-dollar industry, which consists of pharmacies, pharmaceutical companies, medical equipment manufacturers, and medical care services. Millions of Americans, running on a day-to-day basis relies on specialized professionals tasked with controlling these processes. One such system is the medical claims procedure. The processing of a medical billing claim can look like a long and difficult project; however, we are here to break it down into a simple and easy to understand some steps.

First Step:

The first step of the procedure begins with the patient. When the patient arrives at the provider’s office they will require to hand their insurance card over and then complete the doctor’s demographic form. It is essential that all their details are filled in correctly as the demographic form contains pertinent info regarding Social Security or driver’s license details; the name of the actual policy holder as well as any extra and essential information about the policyholder if they differ from the patient; and other basic info such as patient name, age, address and contact details. 

Second Step:

When the demographic form is complete – as well as any other essential paperwork – the patient then sees the specialist and the services required are administered. It is during this procedure that the doctor must record all the various billable services that they rendered to the patient. 

Third Step:

Once the provider has detailed all the billable services they administered the details are passed on to the coder who must then extract the applicable billable codes that will properly reflect the services rendered. 

Four Step:

Another step in the process is sending the billable codes to the medical biller. It is at this point that the codes are inserted into the appropriate medical claim form provided by the medical billing software. Once the codes are put into software, the claim is then mailed for payer reimbursement to what is well-known as a clearinghouse or even directly to the payer. 

Get more information on affordable medical billing services and latest information in medical billing industry at Precision7/.

Malware, Billing Company Theft Equal Health Data Breaches

What is malware? 

It is an umbrella term used to refer to a variety of types of hostile or intrusive software, including computer viruses, worms, trojan horses and other malicious programs. Malware can take the form of executable code, scripts, active content, and other software. 

Medical identity theft occurs when somebody steals your personal information such as date of birth, Social Security Number, health insurance ID. Anything from malware to sophisticated cyber attacks to theft laptops can lead to PHI being compromised. Workers need to be properly trained in healthcare data security measures, and facilities have to make necessary business associate agreements. It will assist put covered entities on the way to work toward prevention and to recover an incident. 

• Malware points out 981 patients’ information at threat 

Cleveland’s MetroHealth System has announced it has suffered a PHI breach after malware was discovered on three of its computers. 981 medical reports of patients who received cardiac catheterizations were potentially compromised in the risk. 

Cleveland’s MetroHealth System, a county-operated non-profit healthcare provider based in Cleveland, Ohio, discovered on July 14, 2014, to March 21, 2015, that malware had infected three Cardiac Cath Lab computers. The malicious software was removed the following day on March, 21.

Cleveland’s MetroHealth initiated an immediate investigation into the malware infection and potential records breach to determine how the software had been installed, the extent to which records had been compromised, the patients who had been affected and whether any records had actually been viewed or copied. While the malware was firstly thought to have been successfully removed, the forensic research revealed the highly sophisticated nature of the software. Some days into the research, it was open that in addition to the malware, a back door had been created allowing the maker of the software full access to the affected machines. That back door remained to unlock until March 21, after three days the malware was removed.  

• Medical billing company theft leads to potential health data breach 

A Medical Management Limited Liability Company worker, who no longer works for the company, copied certain items of personal info from the billing system over the past three years and then illegally disclosed that info to a third party, according to a UPMC report. Potentially compromised information consists of names, dates of birth and Social Security numbers. However, UPMC said there is no proof that information about medical histories or cures was disclosed.

University of Pittsburgh Medical Center has been informed by law enforcement authorities based on their ongoing research that more employee information was stolen than they originally knew, Gloria Kreps, a University of Pittsburgh Medical Center spokeswoman, composed in an email to the Pittsburgh Post-Gazette. This latest information has indicated that worker names, Social Security numbers, details, salaries, bank account numbers and bank routing numbers may have been accessed.

Get more information on medical billing and coding or interested in outsourcing medical billing practices, Precision7 is the perfect choice.