Denial tracking

March 30th, 2009 - Codapedia Editor
Categories:   Billing   Collections   Denials & Denial Management   Practice Management  
0 Votes - Sign in to vote or comment.

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)

2023 ICD-10-CM Code Changes
October 6th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...
Emergency Department - APC Reimbursement Method
September 15th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
Why Medical Coding and Billing Software Desperately Needs AI
September 7th, 2022 - Find-A-Code
It has been said that the healthcare industry is notoriously slow in terms of technology adoption. One need only look at how convoluted medical coding and billing are to know that it needs a technology injection. Specifically, medical coding and billing software desperately needs artificial intelligence (AI).
CMS says Less Paperwork for DME Suppliers after Jan 2023!
August 18th, 2022 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare!  Currently, a supplier receives a signed Certificate of Medical Necessity (CMN) from the treating physician or creates and signs a DME Information Form (DIFs); these are required to be sent with the claim. However, this is about ...
Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association