DENIAL CLAIM ANALYSIS WEBINAR MONDAY, MARCH 29, 2010 Optimizing Billing Practices Billing Claims...
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Transcript of DENIAL CLAIM ANALYSIS WEBINAR MONDAY, MARCH 29, 2010 Optimizing Billing Practices Billing Claims...
DENIAL CLAIM ANALYSISDENIAL CLAIM ANALYSIS
WEBINARWEBINAR
MONDAY, MARCH 29, 2010MONDAY, MARCH 29, 2010
Optimizing Billing PracticesBilling Claims Self Assessment
Your presenters
PresenterStephanie Ceponis, Lead Site Financial
Analyst 213-386-5614 ext. 4534, [email protected]
ModeratorChuck Marquardt, Director of Training
213-386-5614 ext. 4583, [email protected]
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Tools you can use – Feedback Toolbar
RaiseHand
No EmoticonsYes
Feedback Results
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Floating Toolbar
Use the floating toolbar to communicate Use the floating toolbar to communicate in today’s session. in today’s session.
ParticipantList
Q&A
Polling
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5
Q&A
Click Send
Type Question
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Polling
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Webinar etiquette
All phones are muted.
Questions can be asked via chat throughout the session or raising your hand in WebEx.
Lines will be opened at the end for additional questions.
Objectives
The participant will be able to do the following: Complete the Excel workbook, CFHC Billing
Claim Denials Analysis;
Analyze data to identify problem areas in billing claims;
Describe plans of action for a variety of possible denial scenarios.
What are we going to learn?
How to utilize the CFHC denial analysis tool .
Some common denial codes and the key pieces to review to help reduce the frequency of the particular code.
Action plans – ways to reduce denials.
Rejects & Denials
Poll #1
Does your agency work or follow up on rejected or denied claims as part of standard practice? Yes No
Rejects & Denials
Poll #2
Has anyone analyzed the rejects and denials to see where they are coming from? Yes No
Rejects & Denials
Poll #3
What is a common denial code your agency receives? Write in your response to the right of your screen.
Rejects & Denials
Poll #4
What is the purpose of rejects and denials? Write in your response to the right of your screen.
Start thinking…
Poll #5
What can we do to eliminate or minimize the number of rejected claims? Write in your response to the right of your screen.
Start thinking…
Poll #6
Which group in your agency originates the most rejects? Clinicians Front desk/receptionists Eligibility workers Billers Multiple sources
What You Will Need
All RADs from 6 months or less.
A Staff person to enter data. This does not have to be a biller, and could be
administrative staff.
10 – 20 hours of data entry time, depending on the number of claims submitted.
5 Simple Steps
The Billing Claim Denials Analysis can be completed in 5 simple steps:
1. Collect data2. Enter data3. Analyze data4. Create a plan of action5. Implement the plan
5 Simple Steps
The Billing Claim Denials Analysis can be completed in 5 simple steps:
1. Collect data2. Enter data3. Analyze data4. Create a plan of action5. Implement the plan
5 Simple Steps
The Billing Claim Denials Analysis can be completed in 5 simple steps:
1. Collect data
2. Enter data3. Analyze data4. Create a plan of action5. Implement the plan
The Analysis Tool
Overview of the Analysis Tool
An Excel workbook with 5 sheets1.Summary denials sheet
Data entry with some formulas
2.RAD denial data sheet
Data entry tab where the “meat” of the denials gets entered
3.RAD denial summary sheet
Populated from RAD denial data tab – no data entry unless you need to customize
Overview of the Analysis Tool
4.Chart
Data table is on RAD denial summary tab
5.Collection Report
Data entry
Summary Denials Worksheet
Automatically sums the paid, duplicate and denial claims
Divides the number of denials by
total number of
claimsDivides the number
of duplicate and denied claims by the
total number of claims.
Recap – Summary Denials Worksheet
Enter data in cells A through F.
Cells G, H and I use formulas.
Gives you summary data for the whole RAD not just denials.
RAD Denial Data Worksheet
For the code breakdown on the next sheet only one denial
code can be entered
You must put a 1 in this column to
feed the code breakdown on the next sheet
Recap – RAD Denial Data Worksheet
Enter data from RAD into cells A, B, D, E and F.
Only one denial code can be entered into cell G.
A number “1” must be entered into cell H for each completed row.
RAD Denial Summary Worksheet
Cells B and C have formulas
that use information
from the cells in the RAD Denial Data Worksheet
Let’s see a zoom view of this!
Recap – RAD Denial Summary Worksheet
All information is populated from the RAD denial data sheet.
No data entry is needed unless customizing the denial code list.
If customizing, remember to copy the formulas from prior cells.
5 Simple Steps
1. Get the data2. Enter the data
3. Analyze data4. Create a plan5. Implement the plan
Pie Chart
Let’s see a zoom view of this!
Clinical40%
Billing20%
Other20%
Registration
20%
Collection Report Worksheet
$ Owed column has conditional
formatting to highlight amounts
$50 and above.
Analysis Tool Recap
Summary denial and RAD denial data worksheets are the primary data entry sheets.
RAD denial summary worksheet does not have any data entry unless you need to customize the denial codes.
Data table for chart is already formulated – chart will automatically be created from data entered.
TIPS TO REDUCING THE NUMBER OF REJECTED AND DENIED CLAIMS
Common Denial Codes
RAD #0117
This procedure is payable only twice per month Ongoing education and
counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider
RAD #9518
The referring provider must be a Family PACT certified provider The referring Doctor must provide
their NPI# to the rendering Doctor to be reimbursed on Family PACT services.
The NPI# must be in correct field on claim form.
RAD #0315
Recipient information on claim does not match eligibility information on file for this person Verify the name, sex code, date of
birth and client’s ID #
RAD #9655
The frequency limits for this procedure have been exceeded. Resubmit claim with documentation indicating medical necessity for the test Verify if the frequency limit has been
reached prior to rendering services
Lab reservation must be made via the Laboratory Services Reservation System (LSRS) with NPI
Claims must be billed with same NPI reservation was made under
5 Simple Steps
1. Get the data2. Enter the data3. Analyze data
4. Create a plan5. Implement the plan
Planning
Staff trainingChange how information is collectedChange the superbillGet specialized training
Possible Changes
Staff training regarding the completion of the Client Eligibility Certification form.
Modify the superbill to reflect only those procedures your agency provides.
Clearly separate what is in-house lab versus outside lab.
Perform quarterly chart billing audits.
Possible Changes
Create a daily chart review prior to billing.
Create clear steps to rectify questions prior to billing.
Provide training to clinicians regarding coding.
Resources:
Family PACT www.familypact.org
http://familypact.org/en/Providers/policies-procedures-and-billing-instructions.aspx
(PPBI, Provider Bulletins, Superbill)
Resources (cont.)
Medi-Cal www.Medi-cal.ca.gov
http://files.medi-cal.ca.gov/pubsdoco/billing_tips.asp
(Provider manual, Bulletins, CMC info)
5 Simple Steps
1. Get the data2. Enter the data3. Analyze data4. Create a plan
5. Implement the plan
Questions????