WV HFMA Spring Revenue Cycle Workshop 2014 Belinda Bennett & Okey Silman II

 Keys to reducing Denials  Tools to identify Denials  How to reduce Denials  System Related  Staff Related  QA Processes  Denial Committee  Vendor Assistance  Monitoring and Feedback

 Denial Log to track denials from payers  Rebill Logs – why are we rebilling accounts  Vendor review of Denials and issue report  Review of Authorization Denials  i.e. status billed did not mirror authorization in system  RAC Denials  Install a Denial System

 QA System  Automated real-time system in Registration  Manual QA System  Process to obtain authorizations, vendor or hospital staff  Process to identify when a service is pre-certified but when in Radiology a test is added or changed – communication between departments and staff to update the pre-certification  Process to ensure when a status changes for a patient that you notify payers for new authorizations for observations, in-patient, etc.  Flash meeting daily to review authorizations, payer requirements, etc.  Charge Master – possible review  Billing System edits  Computer System  Identify settings that may not be correct, i.e. Revenue Code, CPT/HCPCS codes

 Billing System Edits  Review Payer Contracts Link to a check list for avoiding denials in Payer contracts: et.aspx?id= et.aspx?id=19451  Computer System  Identify settings that may not be correct, i.e. Revenue Code, CPT/HCPCS code, etc.

 Denial Committee reviews  Denial logs and reports  Tracking progress  Provide Feedback to all staff – scheduling, registration, coding, and billing  Provide Feedback to Physicians  i.e. Sterilization Forms required for payers  Authorization issues

 835 posting files – need to watch how the reason codes are being posted.  Each payer is different and may utilize a code differently  Each system is different and may post a reason code differently  Claim Adjustment Reason Codes Claim Adjustment Reason Codes

Reason CodeAdjustment GroupDescription 223CO – Contractual ObligationsAdjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. 223OA – Other Adjustments 223PI – Payer Initiated Reductions 223CR – Corrections and Reversals

 Reduce Denials  Improve Cash  Reduce Net AR Days  Get accounts paid timely without interruption