cdw_mgma_mo_2013
TRANSCRIPT
Successfully Manage Your Denials and Become Mardi Gras Royalty
MGMA of MissouriMay 06, 2013
Chastity D. Werner, RHIT, CMPE, NCP
Learning Objectives
What is your number
Remember when?
Today
Patient workflow
Prevention is key
Tracking results
Celebrate success
What Is Your Number?
Denied Claims
Submitted Claims
______________ = Denial Rate
What Is Your Number?
100 claims a day X 20 days a month
2000 claims
20% denial rate
33% of denials are never recovered
400 X 33% = 132
132 X $100.00 (average reimbursement) = $13,200 monthly
Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2, Walker-Keegan, Woodcock, Larch.13
$158,400 annually
What Is Your Number?
Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2, Walker-Keegan, Woodcock, Larch.13
$10.67 staff time
$1.50 supplied
$1.75 interest
$1.00 overhead_______________________
$14.92
$71,616 annually
Top Inbound Denials
Referring Provider NPI
Diagnosis Code Invalid 2300.HI*BK
Referring Provider NPI
Place of Service Code Is Required and Must Be Valid. 2300.CLM*05-1
Source: GatewayEDI 2013
Top Payer DenialsEligibility
Billing Provider: Entity’s NPI/Rejected for Relation
Billing Provider: Entity’s Tax ID/Reject for Relational Field Error
Referring Provider: Identifier Qualifier Note: At least one other status code is required to identify
Source: GatewayEDI 2013
What
Is Your
Number?
Remember When?
Scheduling
Visit
Printed & Mailed Claim
Forms
Claim Adjudication
Denials & Patient
Collections
Claim Follow-Up Via Telephone
Remember When?
Appointment Books
Dot Matrix Printers
Highlighters
Remember When?
Paper Charts
Misfiled Records
HMOs• Copayments were only $10 - $20• $250 Deductibles
Remember When?
Remember When?
Remember When?
Remember When?
NOF
Remember When?
NotOn
File!!!
Today
Practice Management Software
Automated Eligibility & Benefits• 270/271
Electronic Health Records
Today
Today
Charge Lag Time – 24 hours
Bill Lag Time – 48 hours
Electronic Claim Submission• 837
99213992149921596117
Today
Real Time Claim Adjudication• 977, 276 & 277
Electronic Remittance Advices (ERAs)• Reason Codes- RARC &
CARC• 835• 2014 Reform
Today
Electronic Fund Transfers (EFTs)
Automated 2ndry Claim Filing
Patient Portals
Questions?
Patient Workflow
Scheduling• Capturing information that
counts• Now what?
How did you hear about our
practice?
Patient Workflow
System required fields?
Capturing the right information at the
right time.
Patient Workflow
Prepare Patient for Visit• Collect Previous Balances• Review Financial
Expectations• Price Estimations• Directions• Confirm Details
Patient Workflow
Pre-Visit Paperwork• Electronic Forms• Patient Portals• Kiosks• Patient Financial
Responsibility• Does it fit• Duplication
Patient Workflow
Financial Clearance• System Automation
Task to right person or group
• Eligibility/Benefits Task by plan and requirements
Patient Workflow
Check-In• License• Scan Insurance Card• Confirm System Information• Review Paperwork• Collect Patient Financial
Responsibility Staff Scripts Continued Training Learned Responses
Patient Workflow
Check-Out• Computer Assisted Coding• Real Time Adjudication• TOS
Coinsurance Deductible Deposit
Patient Workflow
Billing• Charge Lag Time• Claim Scrubbing• Bill Lag Time• File Confirmation• Automated Tasking
Patient Workflow
Account Follow-Up/Payment Posting• 277 Files• ERAs• EFTs• Reason Codes• Posting Denials• Filing Appeals
GIGO - Garbage In Garbage Out
Prevention Is Key
Patient Workflow
65.7% Reversed DenialsOn Filed Appeals
Source: Frank Cohen, www.frankcohen.com, 2010
Prevention is Key
GIGO = Leakage in Revenue
Denials• 90% preventable• 67% recoverable
Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2, Walker-Keegan, Woodcock, Larch.13
Prevention is Key
Denial Prevention• Information captured at scheduling• Financial clearance• Identify balances owed• Patient responsibility estimates• TOS collections
Prevention is Key
The game has changed• Practice management
system automation• Batch eligibility & benefits• Automated credit card
payments• Reimbursement managers
Track Results
Post all denials• Post by reason code• Sort reports by reason codes
Dashboards• Financial• Quality of care
Payer fee schedules• CPT Analysis
Track Results
Charge Lag = date charge entered – date of service
Bill Lag = date claim filed – date charge entered
Days in AR = total current receivables/average daily charges
Average Daily Charges = total gross charges/total days
Adjusted Collection Rate = payments/allowable charges
Allowable Charges = charges – contractual adjustments
Questions?
Celebrate Success
Days in AR• Best – less than 35• Average – 35 to 50• Poor – greater than 50
Percentage of A/R greater than 120• Best – less than 12%• Average – between 12-25%• Poor – greater than 25%
Net Collection Rate• Best – higher than 99%• Average – between 95-99%• Poor – less than 95%
Best Performers
Source: Navicure 2012
Celebrate Success
Goals
Marathon not a sprint
Make it fun
Anders Health Care Services
Anders Health Care Services optimizes staff, resources and revenue for hospitals and
physicians by offering solutions and direction to complex practice management issues.
We provide an integrated approach from the financial, operational, compliance and
strategic perspectives.
Contact Information
Chastity D. Werner, RHIT, CMPE, NCP
Health Care Consultant
Anders Health Care Services
314-655-5561 (direct)
314-920-7938 (cell)
Anders’ Practice Strategy Resources
DeAnna Cassat [email protected]
Jessica Johnson [email protected]
Brian McCook [email protected]
John McGuire [email protected]
Brian Meyers [email protected]
Jerrie Weith [email protected]
314-655-5500
www.andershealthcare.com