ICD-10 Transition: Working With Your Referral Partners on Dual Coding
Don't wait until the last minute to discuss ICD-10 with your referral partners. A good ICD-10 communication plan includes direct coordination with referral partners. Contacting your referral partners now will allow you to start building an ICD-10 networking group for sharing information on payer readiness, vendor options and staff training and the information you mine from your referrals may continue to boost your financial performance even beyond the initial implementation date through stronger ties with referral partners. In order to jump start your referral partner communications, we are providing the following letter which you can customize to suit your ICD-10 communication plan . . . .more >>
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ICD-10 & Cash Flow: What Denials Are Ahead?
ICD-10 promises to be one of the biggest medical coding updates in memory. Industry forecasters promise clinical documentation shortfalls, staff productivity losses, spotty vendor readiness, claim payment sluggishness and, at the end of this long line of performance pitfalls, we have been advised to expect double-to-triple increases in claim denials.
Of course, preparations have been extensive. However, many medical financial officers are now saying the "unknowns" are among their last minute concerns and one of those big unknowns is what our denial rates will look like and how can they be resolved . . . .more >>
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Prompt Payment Appeals: Saying "What is Taking So Long" in Optimal Wording
While some initial reports on ICD-10 claim processing have been favorable, many providers are experiencing payment delays and other revenue cycle challenges related to the coding transition. Both CMS and RelayHealth issued claims processing reports reflecting little change in denial rate metrics. According to the CMS report, denials for October, 2015 were about ten percent of submitted claims . . . .more >>
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Prompt Payment Appeals: Saying "What is Taking So Long" in Optimal Wording
Ah, Rejection. You try not to take it personal. After all, you can resubmit. But there is that little step in between that just fails to inspire interest. Research. Yes, the steps in working your claim rejection report look like this: Rejection. Research. Resubmit. However, the chore of working the claims which show up on a claim rejection report can be a top. . . .more >>
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ICD-10: Key Performance Indicators To Monitor
You feel pretty good about your ICD-10 implementation. Clean claims are getting filed daily and payments are rolling in. However, are you measuring and monitoring your ICD-10 impact or just keeping your fingers crossed? CMS is encouraging practices to be looking at several performance measures to make sure that any impact is quickly identified and remediated. . . .more >>
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Clinical Customizations Win Appeals: First in our "How I Won My Appeal" series
This is the first in our series of "How I Won My Appeal" and offers a successful appeal scenario provided by Christine Henderson, RN, of Scituate, MA. Henderson successfully strengthens her appeal letter templates by adding clinical customizations pertinent to the patient's highly specific treatment plan. These arguments are often persuasive in getting payers to apply more flexibility to treatment reimbursement guidelines. . . .more >>
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| Persistence Beyond Initial "No" Wins Appeals: Second in our "How I Won My Appeal" series
This is the second in our series of "How I Won My Appeal" and offers a successful appeal scenario provided by Thomas LaBorde, CPA CIA, Business Manager for LaBorde Therapy Center in Lafayette, LA:
We recently have been appealing a denial for Medical Necessity for about 7 Physical therapy visits. We have been fighting for months and we were at our last level of appeal. We had been denied by 2 external Reviewers. I was browsing through the appeallettersonline.com database to see if I could come up with anything else and found. . . .more >>
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Successful Strategies for Avoiding "No New Information" Denials
Unfortunately, one of the most frustrating and common denial responses from carriers are the words "Denial upheld. No new information submitted."
A No-New-Info appeal response is a clear signal that your organization may be submitting form letter appeals without making claim-specific customizations to the appeal letter. Appeal form letters have become routine in the industry and payers can easily spot an appeal which has been auto-generated using claim data alone. An appeal should provide patient-specific information to support the appeal and the type of information to include depends on the denial. . . .more >>
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How Do Mental Health Parity Laws Impact "Usual, Customary and Reasonable"
Usual, Customary and Reasonable Benefit Adjustments are often ambiguously applied to out-of-network claims and providers are left with little understanding of if the benefit calculation is accurate or not.
While these balances are often the patient's responsibility, many healthcare providers take on the advocacy role by seeking clarification regarding the UCR calculation, appealing excessively large discounts and seeking input on what pricing database was used to calculate the benefit.more >>
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