MEDICAL BILLING BLOG

Many significant coding and billing changes have been introduced in 2013 for orthopedics. The ClaimCare Medical Billing Company has created a 13 minute training video to bring orthopedic providers and practice staff members up to speed on the key 2013 Orthopedic Coding and Billing Changes they need to understand to insure they have no compliance, billing or collection issues as a result of these new rules.

2013 Orthopedic Coding and Billing Changes - (13 minutes)

For more insights concerning orthopedic billing, please check out the following collection of articles: Orthopedic Billing Articles

 

About ClaimCare, Inc.

 

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

 

Medicare has over 200 reason and remark codes they use daily in the process of adjudicating claims. They have recently released the top reasons for medical billing denials and rejections.  Most practices may think the majority of medical billing denials and rejections are based on how the doctor or certified CPT coder chooses to code. This is incorrect. Of course, sometimes it is the case – but most times it is not.

You may be surprised to learn that the top denial and rejection reasons are caused by failures within the work flow of the practice’s office. It is easy enough to want to point fingers at Medicare in frustration, but quite often it is the little things that prevent a practice from being paid in as few as 15 days from submission.  So, if you are experiencing delays in receiving Medicare payments, the culprit may well be one of the issues listed below. Fixing these problems can dramatically speed up your payments from Medicare (and other payers). After all, the best medical billing denial management process is avoding denials in the first place.

2013 top 10 reasons for Denials and Rejections:

                1.   Claim submitted to the Wrong Payer/Contractor

                                a.  New Medicare Advantage programs

                                b.  Should be sent to Railroad Medicare instead of Traditional

                2.   Patient ID Number is Invalid

                3.   Patient DOB does not match Medicare Record

                4.   Patient Name does not match Medicare Beneficiary

                5.   Other insurance primary

                6.   Coordination of Benefits of the primary payer is out of balance

                7.   No Part B coverage (or Part A coverage only)

                8.   Zip Code of place of service invalid (requires 4 check-digit code)

                9.   NPI is invalid for the referring physician

               10.  Invalid Procedure Code for date of service.   

About ClaimCare, Inc.

 ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service.  Still others try to use it to describe what they do daily in the physician's office.

 

If you were to ask your billing department or a current medical billing company (1) what is their Revenue Cycle Denial Management strategy; (2) what process do they use to methodically measure it and (3) what are the quantifiable results of it, you would most likely get a lot of blank stares.

 

Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow. The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. In our experience we've come across many practices with no way of monitoring if the payer is denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10-20 percent of their total revenue.

What is typically missing from troubled billing operations is the lack of the management-reporting expertise needed to extract the data in a concise and meaningful way coupled with a lack of methodical, measured billing process needed to correct mistakes.

 

ClaimCare Medical Billing Services' comprehensive Revenue Cycle Denial Management system has two main purposes. First, to provide feedback on why and how many claims are not being paid on the first submission to the respective payers. The second is to fix these issues. ClaimCare Medical Billing Services' Revenue Cycle Denial Management software databases have been designed to track, quantify, and report on all denials for all payers. The standard output tracks, by payer, the number of claims denied and the reason for the denials. This is coupled with our Dashboard reporting for a quick visual management. With these unique reports our team can easily identify which payers are inappropriately denying claims; we can also compare these payers to their peers for proper trending and follow-up. The unique output for each practice allows us to refine the payer specific rules and build our own rules to prevent future payer denials. Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law (to the extent it exists in the state). Only by quantifying and analyzing the problem can you discover how to improve on the process. A real Revenue Cycle Denial Management system gives you a way to optimize and accelerate cash flow. ClaimCare Medical Billing Services' system has a proven track record of improving revenues between 5-20 percent.

You can take advantage of ClaimCare's Denial Management success with our Old AR Recovery service.

Copyright 2007 by Carl Mays II