Denial management
This presentation is the property of its rightful owner.
Sponsored Links
1 / 12

DENIAL MANAGEMENT PowerPoint PPT Presentation


  • 226 Views
  • Uploaded on
  • Presentation posted in: General

DENIAL MANAGEMENT. WV HFMA Spring Revenue Cycle Workshop 2014 Belinda Bennett & Okey Silman II. Denial Management. Keys to reducing Denials Tools to identify Denials How to reduce Denials System Related Staff Related QA Processes Denial Committee Vendor Assistance

Download Presentation

DENIAL MANAGEMENT

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Denial management

DENIAL MANAGEMENT

WV HFMA Spring Revenue Cycle Workshop 2014

Belinda Bennett & Okey Silman II


Denial management1

Denial Management

  • Keys to reducing Denials

    • Tools to identify Denials

    • How to reduce Denials

      • System Related

      • Staff Related

      • QA Processes

      • Denial Committee

      • Vendor Assistance

    • Monitoring and Feedback


Tools to identify denials

Tools to Identify Denials

  • Denial Log to track denials from payers

  • Rebill Logs – why are we rebilling accounts

  • Vendor review of Denials and issue report

  • Review of Authorization Denials

    • i.e. status billed did not mirror authorization in system

  • RAC Denials

    • Install a Denial System


How to reduce denials

How to reduce Denials

  • QA System

    • Automated real-time system in Registration

    • Manual QA System

    • Process to obtain authorizations, vendor or hospital staff

      • Process to identify when a service is pre-certified but when in Radiology a test is added or changed – communication between departments and staff to update the pre-certification

      • Process to ensure when a status changes for a patient that you notify payers for new authorizations for observations, in-patient, etc.

    • Flash meeting daily to review authorizations, payer requirements, etc.

    • Charge Master – possible review

    • Billing System edits

    • Computer System

      • Identify settings that may not be correct, i.e. Revenue Code, CPT/HCPCS codes


How to reduce denials1

How to reduce Denials

  • Billing System Edits

  • Review Payer Contracts

    Link to a check list for avoiding denials in Payer contracts: http://www.hfma.org/WorkArea/DownloadAsset.aspx?id=19451

  • Computer System

    • Identify settings that may not be correct, i.e. Revenue Code, CPT/HCPCS code, etc.


Monitoring and feedback

Monitoring and Feedback

  • Denial Committee reviews

  • Denial logs and reports

  • Tracking progress

  • Provide Feedback to all staff – scheduling, registration, coding, and billing

  • Provide Feedback to Physicians

    • i.e. Sterilization Forms required for payers

    • Authorization issues


Denial management

Denials are commonly classified as clinical, technical/administrative or underpayments, as the following table from the hfm TOOLBOX illustrates:


Reason codes

Reason Codes

  • 835 posting files – need to watch how the reason codes are being posted.

  • Each payer is different and may utilize a code differently

  • Each system is different and may post a reason code differently

  • Claim Adjustment Reason Codes


Reason code example

Reason Code Example


Objectives

Objectives

  • Reduce Denials

  • Improve Cash

  • Reduce Net AR Days

  • Get accounts paid timely without interruption


Questions

Questions


  • Login