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PALLIATIVE CARE CLAIMS ANALYSIS PowerPoint PPT Presentation


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Are my PC visits being billed?. Why Not?. NO. Are they being paid?. YES. NO. Why are the claims being denied?. Billing Error?. Same Specialty or group?. Hospice Patient?. Other?. What happens with denied claims?. CLOSED. RESUBMIT. PALLIATIVE CARE CLAIMS ANALYSIS.

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PALLIATIVE CARE CLAIMS ANALYSIS

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Palliative care claims analysis

Are my PC visits being billed?

Why Not?

NO

Are they being paid?

YES

NO

Why are

the claims

being

denied?

Billing Error?

Same Specialty or group?

Hospice Patient?

Other?

What

happens

with denied

claims?

CLOSED

RESUBMIT

PALLIATIVE CARE CLAIMS ANALYSIS

  • RESOURCES & ACTIONS

  • Who does the billing? Ask the manager of the unit for information on the billing process, number of visits billed and not billed. Reasons not billed?

  • Who logs in payments /reviews denied claims?

  • Ask the manager for info on claims paid vs. denied.

  • Ask to see the denial report and meet with the manager to review the denial report together. Can you identify the reasons for denial?

  • You need to resubmit a “corrected claim”.

  • If claim is denied again, find who is responsible for filing appeals? Ask the person for number of denials and appeals and results of appeals.

Denied

Approved

Date: 9/15/2008


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