Denial tracking
March 30th, 2009 - Codapedia Editor
Claims denials have the following outcomes, none of them good:
- Collection of revenue is delayed
- Collection for the service never happens
- Staff members spend time and energy researching and resubmitting claims
- The denial is lost in the A/R system and never worked
There are many sources of denials, some caused and controlled by the practice, and some by the payer. The goal of denial tracking is two-fold: allows you to see the causes of denials within your practice's control and improve your systems and allows you to negotiate contract termswith payers for inappropriate claims processing.
However, if you categorize your denials broadly, "Medicare adjustment" or "My Best Insurance Company adjustment" you will lack the data you need.
Categorize your denials with more specificity and detail. Post all denials, even if the follow up will happen later. Don't simply fix and resubmit or you won't collect the data you need to learn from the denials and improve your work processes. Use reason codes that explain the reason for the denial, and that can be rolled up into broader categories.
For example, registration errors can include eligibility, benefit and referral errors, as well as keying errors.
Coding errors can include modifier use, bundling errors, diagnosis code errors,units, and deleted CPT® codes.
Payer processing errors might occur if they pay the wrong number of units, pay incorrectly based on NCCI, or don't recognize standard CPT® modifiers and their uses.
Collect the data by volume, dollar value, payer, provider, etc.
After you have collected this data, you can use it to give feedback to your staff, and to improve the billing process in your office. If you find that a particular payer always processes certain types of claims incorrectly, and that it costs you significant revenue, use that information when re-contracting with the payer.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Artificial Intelligence in Healthcare - A Medical Coder's PerspectiveDecember 26th, 2023 - Aimee WilcoxWe constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?
Specialization: Your Advantage as a Medical Coding ContractorDecember 22nd, 2023 - Find-A-CodeMedical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)December 19th, 2023 - Aimee WilcoxChronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike AgainDecember 12th, 2023 - Aimee WilcoxAccording to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for AppendicitisNovember 14th, 2023 - Aimee WilcoxWith approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn StaheliCOVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
