Optimizing Billing Practices Billing Claims Self Assessment

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Optimizing Billing Practices Billing Claims Self Assessment. Denial claim analysis Webinar Monday, March 29, 2010. Your presenters. Presenter Stephanie Ceponis, Lead Site Financial Analyst 213-386-5614 ext. 4534, ceponiss@cfhc.org Moderator Chuck Marquardt, Director of Training - PowerPoint PPT Presentation

Transcript of Optimizing Billing Practices Billing Claims Self Assessment

  • DENIAL CLAIM ANALYSISWEBINARMONDAY, MARCH 29, 2010Optimizing Billing PracticesBilling Claims Self Assessment

  • Your presentersPresenterStephanie Ceponis, Lead Site Financial Analyst213-386-5614 ext. 4534, ceponiss@cfhc.org

    ModeratorChuck Marquardt, Director of Training213-386-5614 ext. 4583, marquardtc@cfhc.org

  • * Tools you can use Feedback Toolbar 2

  • *Floating ToolbarUse the floating toolbar to communicate in todays session. 3

  • *Q&A 4

  • Polling 5

  • Webinar etiquetteAll 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.

  • ObjectivesThe 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 & DenialsPoll #1

    Does your agency work or follow up on rejected or denied claims as part of standard practice?YesNo

  • Rejects & DenialsPoll #2

    Has anyone analyzed the rejects and denials to see where they are coming from?YesNo

  • Rejects & DenialsPoll #3

    What is a common denial code your agency receives?Write in your response to the right of your screen.

  • Rejects & DenialsPoll #4

    What is the purpose of rejects and denials?Write in your response to the right of your screen.

  • Start thinkingPoll #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 thinkingPoll #6

    Which group in your agency originates the most rejects?CliniciansFront desk/receptionistsEligibility workersBillersMultiple sources

  • What You Will NeedAll 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 StepsThe Billing Claim Denials Analysis can be completed in 5 simple steps:Collect dataEnter dataAnalyze dataCreate a plan of actionImplement the plan

  • 5 Simple StepsThe Billing Claim Denials Analysis can be completed in 5 simple steps:Collect dataEnter dataAnalyze dataCreate a plan of actionImplement the plan

  • 5 Simple StepsThe Billing Claim Denials Analysis can be completed in 5 simple steps:Collect dataEnter dataAnalyze dataCreate a plan of actionImplement the plan

  • The Analysis Tool

  • Overview of the Analysis ToolAn Excel workbook with 5 sheetsSummary denials sheetData entry with some formulasRAD denial data sheetData entry tab where the meat of the denials gets enteredRAD denial summary sheetPopulated from RAD denial data tab no data entry unless you need to customize

  • Overview of the Analysis ToolChart Data table is on RAD denial summary tabCollection ReportData entry

  • Summary Denials Worksheet

  • Automatically sums the paid, duplicate and denial claimsDivides 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 WorksheetEnter 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 enteredYou must put a 1 in this column to feed the code breakdown on the next sheet

  • Recap RAD Denial Data WorksheetEnter 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 WorksheetLets see a zoom view of this!

  • Recap RAD Denial Summary WorksheetAll 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 StepsGet the dataEnter the dataAnalyze dataCreate a planImplement the plan

  • Pie Chart

  • Lets see a zoom view of this!

  • Collection Report Worksheet

  • $ Owed column has conditional formatting to highlight amounts $50 and above.

  • Analysis Tool RecapSummary 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 CLAIMSCommon Denial Codes

  • RAD #0117This procedure is payable only twice per monthOngoing education and counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider

  • RAD #9518The referring provider must be a Family PACT certified providerThe 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 #0315Recipient information on claim does not match eligibility information on file for this personVerify the name, sex code, date of birth and clients ID #

  • RAD #9655The frequency limits for this procedure have been exceeded. Resubmit claim with documentation indicating medical necessity for the testVerify if the frequency limit has been reached prior to rendering servicesLab reservation must be made via the Laboratory Services Reservation System (LSRS) with NPIClaims must be billed with same NPI reservation was made under

  • 5 Simple StepsGet the dataEnter the dataAnalyze dataCreate a planImplement the plan

  • PlanningStaff trainingChange how information is collectedChange the superbillGet specialized training

  • Possible ChangesStaff 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 ChangesCreate a daily chart review prior to billing.Create clear steps to rectify questions prior to billing.Provide training to clinicians regarding coding.

  • Resources:Family PACTwww.familypact.orghttp://familypact.org/en/Providers/policies-procedures-and-billing-instructions.aspx(PPBI, Provider Bulletins, Superbill)

  • Resources (cont.)Medi-Calwww.Medi-cal.ca.govhttp://files.medi-cal.ca.gov/pubsdoco/billing_tips.asp(Provider manual, Bulletins, CMC info)

  • 5 Simple StepsGet the dataEnter the dataAnalyze dataCreate a planImplement the plan

  • Questions????

    **How to Talk to Teens About Long Acting Reversible ContraceptivesHow to Talk to Teens About Long Acting Reversible ContraceptivesHow to Talk to Teens About Long Acting Reversible Contraceptives*There will be times during the presentation that we want to hear from you. We will open a short poll and ask you to choose your answer to the questions posed. After we view the results, we will need for you to close the polling window by clicking the minus sign in the upper right corner of the panel. We will remind you again when we get to that place in the presentation.***Polling question wait for participants to give some answers*Polling question wait for participants to give some answers*Polling question wait for participants to give some answers*Polling question wait for participants to give some answers*(click for main bullet points)*(click for main bullet points)*(click for each main bullet point)*(click to start the steps)*(click to start the steps)*(click to start the steps)*(click for each round bullet point)*(click for each round bullet point)*(after review of this slide, flip to the actual workbook)*(click through bullet points)*(after review of slide, flip to excel workbook)*(after review of slide, flip to excel workbook)*(after review of slide, flip to excel workbook)*(click through bullet points)*