Gayle,
The norm in the industry is to work follow-up of denied claims [for reasons like "Cannot ID the patient"] a variety of different ways. Whether the way in which your RCM partner conducts its follow-up efforts meets your expectations is an entirely different matter. Industry follow-up methods and protocols vary greatly.
I think a more impactful and strategic approach to follow-up is to eliminate the need for follow-up. Ben Franklin's axiom that "an ounce of prevention is worth a pound of cure" could not be more appropriate than in the world of medical claims denial and reject management. I know firsthand. I spent 15 years as a healthcare consultant and "inside" revenue cycle manager to the imaging world prior to moving to a 3rd-party independent RCM company, and I struggled with such concerns every day.
Preventing denials and rejects will provide your practice the greatest return. There is always revenue loss associated with denied and rejected claims. Follow-up methods and practices vary. You get what you pay for. If your follow-up expectations do not match with your RCM partner's, there could be significant underperformance.
On the other hand, if you work to prevent denials and rejects, and your efforts provide fruitful, you will see significant improvement in collections. There are a number of ways to reduce denials and rejects beginning with a regular review of their source. If you have not already done so, request a regular report of denied and rejected claims (number and charge value). Assess the root cause of the most costly denials. Devise a plan with your hospital and RCM partner to materially reduce or eliminate those denials. You should identify trends of breakdowns and work with your RCM partner to prevent and eliminate the breakdowns. A place to start is with physician dictation reviews and compliant dictation training & denial prevention. Create custom billing rules, specific to your practice. Perform automated billing history reviews and eligibility checks where possible. Bidirectional communication with the billing company is necessary when additional details are needed. All of these actions are designed to prevent denials and rejects from happening so that you do not need to be overly concerned about the "practice of follow-up".
Not all denials and rejects can be prevented. Work together to set follow-up expectations – custom plans if you will. Set expectations, when denials are received, you expect they aggressively work them. For instance, coding denials are only worked by coding staff. AR needs a personal touch assisted by advanced technology. Ensure that they query and review payer policies and hospital information systems, secure additional documentation, and call payers for additional details when necessary to successfully adjudicate the denied claims.
I would welcome the opportunity to share more with you or at the very least network with you.
Maria Larsen
Senior Vice President, Client Services and Business Development
INTEGRATED MEDICAL PARTNERS
EMPOWERMENT. INNOVATION. RESULTS
Maria.Larsen@integratedmp.com
D|414-359-5541 C | 516-375-9055 F | 866-636-2198
www.integratedmp.com
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Maria Larsen
Client Account Executive
Integrated Medical Partners
Milwaukee WI
(414) 359.5512
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Original Message:
Sent: 02-10-2020 14:47
From: Gayle Schreier
Subject: Norm in the industry with billing companies
I am trying to understand the norm in the industry:
If a billing company receives from Medicare: Can't ID the patient:
Is the norm in the industry to just text or send a bill to the patient that Medicare can't ID them, or is it to look in the hospital system and correct the information on file with what the hospital has?
Thanks for the feedback.
Gayle
Gayle Schreier, MBA
Business Manager
Roper Radiologists, PA
316 Calhoun Street
Charleston, SC 29401
843-724-2015
843-720-8359 fax
Gayle.Schreier@rsfh.com
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