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Re: [MedicalBillers] Provider's Major Payers: Audit Technique Proposal

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  • JOSETTE THOMAS
    HOW ABOUT JUST MASTERING THE CRAFT/SPECIALTY BILLING AND NOT HAVE THAT MUCH DENIALS OR REJECTIONS TO BE THAT MUCH OF A PROBLEM IN THE FIRST PLACE. THIS
    Message 1 of 2 , Oct 28, 2004
      HOW ABOUT JUST MASTERING THE CRAFT/SPECIALTY BILLING AND NOT HAVE THAT MUCH DENIALS OR REJECTIONS TO BE THAT MUCH OF A PROBLEM IN THE FIRST PLACE.  THIS PERTAINS TO BILLING AND KNOWLEDGE OF CCI.
       
      WHEN I AM ENTERING DATA, IF I HAVE ANY DOUBT ABOUT 1. COB 2. REFERRAL 3. PERCERT 4. OR JUST BENEFITS I MAKE THAT ONE PHONE CALL.  ITS IN MY CONTRACT TO PROVIDE A COPY OF ALL PTS INS CARD.  THIS PERTAINS TO INFORMATION TO DO THE BILLING.
       
      NOW, WHEN IT COMES TO THE INS CO ERRONEOUSLY, JUST PLAIN DENYING AND REJECTING CLAIMS FOR NO APPARENT REASON, OTHER THAN THEIR COMPUTER GLITCHES, NOT VERY MUCH YOU CAN DO ABOUT THAT.  HOWEVER, THERE ARE NOT THAT MANY TO BE A PROBLEM.
       
       
      JOSETTE THOMAS
      ACCURATE BILLING CENTER (OWNER)
      MEDICAL BILLER/CONSULTANT/INSTRUCTOR/COORDINATOR
      EMAIL:ABCMDBILLER123_55@...
      ----- Original Message -----
      Sent: Tuesday, October 26, 2004 10:47 AM
      Subject: [MedicalBillers] Provider's Major Payers: Audit Technique Proposal

      Questions: Observations

      I’m searching for a general consensus and feedback on an auditing technique I’m proposing for implementation.

       

      • Do any of you log and track the number of phone calls you make to payers?
      • How much time – hours, days, weeks - do you devote to this task?
      • Is the task random, structured or on an as needed basis?
      • Is the price of this task included somewhere in your contract?
      • Do you log and track your denials?
      • Roughly, what percentage of your claims is denied on a per-submission basis?
      • Do you perform a trend analysis on these denials to categorize them?
      • Do you know the 5 major payers of your clients? 

      Audit Technique: Proposal

      I have a mental health client whose primary payers are – Independence Blue Cross (IBC), Aetna , Cigna, Amerihealth of NJ, Mental Health Network and United Behavioral Health.

       

      Note: IBC, Aetna and Amerihealth of NJ (owned by IBC) carve their mental health benefits out to Magellan. All denials for these carriers would come from Magellan.

       

      To save time, money and run my business more efficiently, I am proposing to:

      • Trend my denials of the 5 major payers of each client on a daily or weekly basis
      • Create a spreadsheet with rejection/denial info based on denial categories
      • Gather info needed to resubmit the claim – documentation, COB info, coding issues..
      • Resubmit everything at once to the manager of the claims department along with the spreadsheet noting the required changes.
      • I would do this with certified mail on a biweekly or monthly basis.
      • I would gauge the responses to see how effective this measure would work.
      • This would allow me time to follow up on info submitted within a reasonable time.
      • When I make that phone call, it would not be to someone who was not familiar with the situation.

       

      Do anyone see anything that I may have overlooked?

       

      Thank you in advance for your feedback.  I'm just looking for a more dynamic way of taking care of the major payers' denials.

       

      If this worked, I would like to implement it with all the payers at some point.

       

      Viola




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