Using denial tracking to improve collections
April 10th, 2009 - Codapedia EditorHere are some examples of denials that a practice should track to be sure that they are paid correctly by the insurance company. Set up a denial type for each of these.
Fee Schedule Issues:
- Wrong amount paid per the contracted fee schedule. May be too high or too low
- Modifier 80 paid incorrectly. If paid at less than 20% or 25% of commercial fee schedule amount, or 16% of Medicare fee schedule amount, may be paid at wrong level
- Payments for other modifiers (50, 51, 59)—were they paid correctly
- Evaluation and management services on the same date as procedures, -25 and –57 modifiers
- Network problems with TPA’s and networks—being asked to take a reduction if you are not part of the network
Incorrect processing:
- Multiple procedures, modifiers (does the staff really know how to use the NCCI edits, and to appeal claims that are incorrectly denied?)
- Modifiers have a lot in common with monopoly
- Unit issues. We bill for 5 units and are paid for 1 unit
- Codes that the insurance company says are “one” and CPT® and we say are “each”
- Variation in processing from claim to claim
- Specific billing for their processing
- Anesthesia quirky requirements
- Lines with $0 payments
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