We need you to judge our monthly Medical Billing Tip of the Month contest! Listed below are the three top tips submitted this month (out of the many great ideas we received!). Just read them over and then post on our Facebook page which number is your choice for Medical Billing Tip of the Month. You can also post your choice in the Comments box here on our blog. Either way, be sure to vote before the deadline of Wednesday, September 5! The winner will receive a $250 American Express Gift Card and the acclaim of their peers. Here are the candidates:
1. Use the Account Activity Report Effectively to Identify the Unpaid and Underpaid
Go to Reports – > Productivity & Analysis – > Account Activity report -> Change the date as “Year to Date”
Just click the refresh button to view the report for all the codes submitted from Jan 2012 to present date.
Here’s how to use this report effectively to know the status of a particular code for a specific payer:
- Set the Account Activity Report for update as “Year to Date.”
- Go to Customize and update the CPT in the Procedure column. You can list multiple CPT’s using a semicolon.
- Reports get generated for these codes submitted to all the payers year to date.
- Convert the report into Excel and identify the payers which paid low for these codes.
- You can use this report to identify the status of the codes in a set. For example, Consult codes, New patient codes, X-ray codes, Surgery codes, MRI codes, PFT set of codes (Cardiology), Doppler U/S, Lexiscan nuclear stress test etc.
- Identify the unpaid and underpaid codes by carrier by using this report.
You can use these reports effectively for specialty practices in which the provider performs surgeries. When the provider performs a specific surgery which was billed with high dollar amount, he will be curious to know the status of the high billed claim. By using this report, we can identify whether all the payers are paying accordingly to the fee schedule rate or not. The non-paying and underpaying carriers can be identified easily by using this report.
2. Bill Miscellaneous Codes Separately
My billing tip is to bill any miscellaneous codes on a separate encounter. That way the office visit or other services that have specific codes can go through effortlessly while the miscellaneous code gets stopped for review. This method has reduced my claim processing by approximately half for claims that would have included a miscellaneous code.
3. Control the Top 10 Internal & External Denials Using the Denial Summary Report
We are using the Denial summary report to control the internal and external denials in our providers’ practices
Go to Reports > Payments > Denial Summary > Change the date to “Year to date.”
By generating the report, you can view the claims denied with the denial code and the total amount. Just generate the report into an Excel spreadsheet and sort the denials in descending order by total amount. You can also drill down to the billed amount to review the CPT and the carrier for a particular denial code. Then categorize whether the denial is internal or external. Here is the report for reference:
For example: Co-22 – Payment adjusted because this care may be covered by another payer per coordination of benefits.
Ex: C0-26 – Expenses incurred prior to coverage.
Ex: Co-27 – Expenses incurred after coverage terminated
Internal Denial: The above denial is related to eligibility and we need to categorize only the eligibility denial based on the Kareo plan. If we have the Kareo “Complete” plan, we should have checked the eligibility before submitting the claims. Then it falls in the Internal Denial category.
External Denial: If you don’t have the option to check eligibility within Kareo, then the denial falls in the External Denial category. We can stop these denials by changing to the Kareo “Complete” plan or by checking the providers’ websites and/or educating the front office to check eligibility.
Denials other than eligibility should be checked and sorted into Internal & External categories.
Using this denial summary, we need to categorize the denials as Internal & External denial by the top 20 denial codes. Based on the type of denial, we need to educate our team to reduce these denials. If most of the denials are related to Internal error, we need to provide guidance and education to the team to reduce such errors in the coming months.
For External denials, we need to co-ordinate with the coding team and provider office to stop the denials such as “denied as non-covered service,” “rendering provider is not eligible,” “Pt enrolled in Hospice.” etc. We need to educate the providers to document the medical records more specifically for the service rendered to avoid such denials.
Steps to be followed to reduce denial %:
- Generate the Denial summary from year to date and convert into spreadsheet
- Sort the denial by descending order by total billed amount
- Categorize the External and Internal denials from the Top 20 denials
- Identify the Root cause of the Denial
- Create a good solution to reduce those denials one by one with the help of coding expert
- Educate the team and provider office with the perfect solution for these denials
- Next, you will see the denial percentage reducing drastically in the coming months
Denial Category Metric:
If a practice gets less than 5% of denials in the total monthly billed amount, then the practice is in the “Best” category. More than 5% denials should be monitored and need probe review to bring down the denials. The clean claim percentage can be increased by using the report effectively
Best Practice - Less than 5%
Average - Between 5 and 10%
Alarm Bells - Greater than 10%
Conclusion: Managing your denials = Improving your revenue cycle.
Which tip is your top choice? Vote now on our Facebook page or in the Comments box on this blog. You have until Wednesday, September 5, to vote! We’ll announce the winner in our September newsletter.