March 5, 2015

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Monitor and Escalate Prompt Payment and Remittance Transparency Violations Before ICD-10 Hits

Getting paid promptly by payers is an ongoing challenge. State and federal prompt payment laws have pushed carriers to enhance prompt payment performance. However, the ICD-10 transition set for Oct. 1, 2015 will likely impact payer claim processing time and is expected to at least double denials.

Your ICD-10 planning should include a review of. . . . Keep reading this article at AppealLettersOnline.com

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To assist with prompt payment escalation and remittance transparency under ICD-10, we have developed the following document available in the AppealLettersOnline.com Download Library.

  • ICD-10 Prompt Payment and ERA Clarification Guidance (new content!)

We also have state-specific letters citing state prompt payment regulations for each state.  Go to the AppealLettersOnline.com Appeal Letter Repository to review these state-specific appeal letters. If your state has issued any prompt-payment guidance related to ICD-10, please let us know by emailing t.tipton@appealsolutions.com.

Access these appeal letters at AppealLettersOnline.com

Payer Spotlight: Medicaid
Performance Concerns Amidst Medicaid Population Growth

Excerpt from AthenaHealth Payerview Report which measures payer performance on a number of metrics:

"Medicaid is an important part of many providers' lives.  Serving the Medicaid population is the right thing to do, but it is rife with challenges.  Some state Medicaids are high performers in their category, while many remain among the slowest paying, least transparent payers overall.  Working with Medicaid is anything but easy.  (Note: To be clear, we are not referring to what they do for patients ó this is only about tracking how easy or difficult it is for providers to work with them.)  As enrollment is expected to jump from 56 million in 2013 to 85 million by 2021, those who learn to work most efficiently with the Medicaidís common issues will be more successful.

Slowest to pay out. Compared with other payers, Medicaid is consistently the slowest in days in accounts receivable (DAR) between charges submitted and payment received.

Highest denial rates, least transparent. When claims get denied, itís important for payers to return them with Electronic Remittance Advice (ERA), including clear next steps and denial explanation.  Unfortunately, Medicaid has the highest denial rate ó and also the lowest ERA transparency.

Medicaid rankings signal that providers need to get help with revenue cycle, denial and enrollment services."

Contact Tammy Tipton at t.tipton@appealsolutions.com to schedule a customized denial management webinar for your staff covering denial avoidance and effective appeals.

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