DON’T BE IN DENIAL!

STEPS TO RESOLVE “DENIAL” Identification Reduction Avoidance

TRIVIA QUESTION Where does denial management start?

AGENDA Registration Charge Capture Coding Claims Payment Posting AR and Denial Management

PATIENT SCHEDULING Patient / responsible party address Telephone number Insurance Place of employment (both adults) Emergency contact information

REGISTRATION Verify Demographic Scan (or copy) insurance card front and back Identification

VERIFICATION Verify coverage Benefits Document results

PRIOR AUTHORIZATION Make sure you obtain CO197, PI197, CO38 Document account Education

CHARGE CAPTURE Complete charge capture EMR Fee Ticket Audits

CHARGE CODING Certified coders Auditing EMR Coding Audit Continuing Education

POSTING AND SCRUB Technology Accuracy EMR Performance

CLAIM SUBMISSION Claim submission Claim Edits Reporting Trending

CLEARING HOUSE Claim submission Acceptance rate Rejections

PAYMENT POSTING Automated posting vs manual Contracts set up in the practice management system Zero pay posted Payments posted line item Do balances move properly

DENIAL MANAGEMENT Denial Codes CO18, CO109 Work queue set up Expectations Tracking Education

DENIAL CODES – WQ SET UP Coding Team - CO97, CO4 Insurance Team - CO16, CO197, CO29 Self Pay Team – PR27, PR26 Contracting Team CO242 Credentialing Team – B7 Move balance to patient due - PR1, PR131

EXPECTATIONS All denials posted to the account Denials populate WQ the next day All denials worked each day Written policy / procedures Each WQ is zero each day

TRACKING Dailey / weekly / monthly totals What can be fixed ASAP What area’s need work Trends

EDUCATION Department Providers Provider Representative Patient

INSURANCE FOLLOW UP WQ Set up  UHC, Medicare, Medicaid No response from appeal No response from claim  What is the average payment time frame

SELF PAY BALANCES Statements Outbound calls Payment plans Default Payments Third Party Collection

QUESTIONS

PRESENTER INFORMATION Marcy Marquis, PCS, CRCP-P Healthcare Consultant