Stop Fighting Denials! Road to ICD-10 Part II @Ken_Edwards01
#CureMDWebinar
Presenter
Ken Edwards Senior Billing Manager, CureMD
Webinar #1: Review In our previous webinar in ‘The Road to ICD-10’ series, most attendees opted to go for the ICD-10 conversion on their own The results:
What is your strategy for ICD-10 so far? Poll results (single answer required ): Go at it alone
44%
Outsource to a billing company
31%
Bring an ICD-10 Consultant on board
25%
ICD-10 Does Change EVERYTHING
Statistic /Matrix
Current ICD-9 Environment
Denial Rate
15%
Increase 100 %
Claim Error Rate
3%
6 – 7%
Claim Turn around
45 Days
55-75 days
Coding Speed
Varies depending on proficiency of your coder
Increase by 18 minutes on average
Nonclinical person
Clinical Input Required
Denial Management
Post ICD-10 Projections
Quick Poll
What is your average monthly claim denial rate ?
Do you have a Denial Management Strategy Post ICD-10 ?
Focus Areas
. Evaluating Denial Management Preparedness . Clinician role in denial prevention and defense . Resources devoted to coding support . Strategic deployment of technologies
Focus Area -1
Evaluating your Denial Management Preparedness Questions to ask Yourself How many educational sessions have been held for ICD-10 ICD-10?
How are we retrofitting our report infrastructure to monitor denials?
Have we completed a chargemaster review?
Are we engaging not just rank-and-file medical staff, but also physicians?
Have we reviewed all our contracts with our payers?
Have we aligned and assigned budgets for denial management activities?
What is our strategy to minimize documentation burden on physicians?
Have we reviewed our Revenue Cycle Matrices ?
Focus Area -2
Physician’s Role post ICD-10 Physician participation in denials management will need to increase under ICD-10
.
Be aware of the depth and types of documentation they will need to provide
.
before claims processing Add clinical perspective and input when denials occur
Tip # 1 :
Conduct a Comprehensive documentation gap analysis What are you missing ?
. . . . . . .
Disease type is not documented Disease acuity is not documented Documentation not found at all Site speciďŹ city is not documented Disease stage is not documented Laterality is not documented One or more details for a combination code
Tip # 2 :
Minimize Documentation Burden
. .
Deploy Medical Intelligence or templates that guide physicians on required documentation Let someone else do the typing for them! Physicians should concentrate on the quality of information only. The Remedies
Pros
Cons
Hire a scribe
Professional
Cost & time
Dictation software
Cost effective
Not discrete
Transcription service
Cost effective Discrete Time effective
Talk to Joe Martin for CureMD Discrete Transcription Services at joe.martin@curemd.com
Focus Area -3
Resources for coding support Pinpoint a person to track and trend denials; someone accountable for contacting the insurance plans, making necessary corrections, and resubmitting claims.
Consider employing a full-time physician as head of denial management or contracting with clinical specialists
Make sure that every department is on board with the changes in their workow for ICD-10.
Focus Area -4
Strategic deployment of technologies The claims denial system your practice uses today may no longer be sufďŹ cient post ICD-10
Clearing House
Scrubber
Claims
ERA
Eligibility
Prior Authorizations
Payment Portal
Referrals
Claim Status
Analytics
Front Desk
8% of total claims submitted are rejected due to eligibility issues
Auto Eligibility Verification Checks . Deductibles . Co-pay collection . Coinsurance
Credit Card Payment Facility Collect Patient Responsibility. Post ICD-10 even a small leakage in your revenue stream will have a huge impact on your practice.
Link: Patient Collections: 7 mistakes your practice should avoid
Medical billing departments
Integrated EMR & PM solution
Advanced Claim Scrubber
Automatic Coding
Catches more than 98 % of errors. Runs
Seamless data exchange
thousands of rules on each charge within 5-7 seconds.
Clean Claim Checks
The Right Clearing House
In-built in most Practice Management
Multiple payer solution
Systems
Trending data on denials and under payments Clean claims HIPAA Compliant
Clean Claim Checks vs Claim Scrubbing
Clean Claim Checks VS Claim Scrubbing Claim Scrubber
Clean Claim Checks
Ensures CPTs & ICDs are entered correctly Ensures CPTs & ICDs are entered correctly t
Ensures field completeness
Available on the charge page
Have to check individually in the incomplete claims section
Checks formats and validity of insurance policies Educates on correct coding by suggesting corrections
How does a claim scrubber help?
.. .. ..
A pre-claim submission tool in your application IdentiďŹ es errors prior to claim submission Eliminates manual claim checking Reduces claim rejections & denials Improves turnaround time by 8-10 working days Ensures all claims get paid in the ďŹ rst go
Claim
What does it check?
.. .. .. .. .. ..
NCCI (Comprehensive & Mutually Exclusive) Local Coverage Determinations Insurance Policy Format Checks Address Validation EDI File Structural, Claim Level Edits Gender & Age Restrictions (CPT & ICD Checks) Updated CPT & ICD-10 Libraries Medicare Member ID Gender & Age SufďŹ x Checks Claim Level Dates Taxonomy Codes Validation Waived CLIA Number Validations CLIA, NDC, DEA Format Checks
Advanced Claim Scrubbing is the Secret Ingredient to CureMD’s RCM Service Success !
Case Study CureMD
The results:
.. .. .
50% increase in efficiency (lesser billing hours) 97.8% of claims reimbursed on first submission Faster reimbursements Insurance Turnaround – 15 days or less Minimum manual effort Consider Outsourcing!
Client Retention Ratio : 99 % Practices are happy with our Medical Billing Services
Intrigued ?
.
Who can use a Claim Scrubber? Practices
.
Billing companies
..
.
Practice Management Vendors
Scrubber for CureMD Users Simple integration Incorporated into the application within 2-3 business days
. .
Scrubber for non-CureMD Users Upload Claim files to CureMD’s scrubbing portal Integrate Scrubber into your Practice Management System via API*
Quick Poll
What area would you like us to cover in the next webinar of the Road to ICD-10 series?
QA &
Session
Need Help? Request a demo to see how CureMD can facilitate your practice for ICD-10 Get in touch with our billing experts at (212) 852 0279 ext 381 For further inquiries regarding Claim Scrubber, send us an email at wayne.henderson@curemd.com
Thank you! Look out for our email, containing the webinar recording and a free eBook