Monthly Archives: March 2014

Medical Claims

 

Did you know that 34% of medical claims submitted are rejected by the insurance company?

A claim may be denied for several reasons. Many times it’s a simple error that was made when submitting the claim, such as, the form was not filled out correctly or all the information was not provided. Unfortunately, the insurance company will NOT tell you the reason for the denial and many of these claims end up in an “unbilled pile.” Most practices concentrate on larger claims first and the smaller claims are put on the backburner. However, more likely than not, the patient is billed for the denied services.

Understanding the reasons why medical claims are denied can help limit the number of these denials. Also, carefully review each denied claim and resubmit the claim to the insurance company to obtain payment for the services rendered.

Needing medical care can be stressful and overwhelming.

 

 

The Go-Giver

Just finished listening to the audiobook: The Go-Giver By Bob Burg and John David Mann. I read this book years ago but going through it again gave me new perspectives.

Highly recommended!

 

The ICD-10 Challenge: Are You Ready?

The Centers for Medicare and Medicaid Services (CMS) has mandated that hospitals and healthcare providers begin using the ICD-10 classification systems by October 2014.  The ICD-10 transition takes time, planning and preparation, therefore medical practices should continue working toward compliance. According to precyse.com, the move to ICD-10 presents 4 major challenges and risks to practices and clinics:

1. Financial Risk – The mandated changes present possible financial risk to offices if coding is not completed in a timely and accurate manner. In addition, poor documentation and code selection could lead to the inability to drive severity of illness and medical necessity leading to unnecessary denials, appeals, and re-works.
2. Compliance – U
nder Health Information Technology for Economic and Clinical Health (HITECH) and Patient Protection and Affordable Care Act (PPACA), the requirements for quality reporting and codified data to support health information requirements require coordination with clinical documentation specificity to support ICD-10 coding guidelines.
3. Patient Throughput – These changes are estimated to reduce coder productivity by 10% to 50% for the first 9 months post-transition, and reduce physician productivity by up to 10%. Relevant and targeted education can reduce this impact by ensuring changes to processes to reduce bottlenecks and lost time. This maximizes time with the patient and reduces time spent fighting authorization and payment battles.
4. Varying Levels of Staff Knowledge – Varying levels of knowledge are required in the physician office and ambulatory settings. Some employees will need to know the basics of how to understand a code and do authorization checks, while others need to know in-depth information on the coding and/or documentation requirements for ICD-10.