2 min read

February primeCLAIMS Blog Spotlight

By Prime Care Tech Marketing on Thu, Feb 25, 2016 @ 02:00 PM

iStock_000023184029_Small.jpgPresent on Admission, handling rejections, and shortening the revenue cycle topped this month’s key claims management blogs. Here are the key topics for this month:

To get paid or not, the answer could be a simple “Yes” or “No” – POA

Some SNF providers strongly assert that HAC-POA (Hospital Acquired Condition-Present on Admission) indicators do not apply to claims submitted to SNFs. Yet, recently an entire batch of claims submitted to a large insurance carrier was rejected, because the SNF provider’s billers had not included the POA indicator.

  • What is a Present on Admission Indicator?
  • Why POA could be important to SNFs
  • How should billers use the POA?

No pain, no gain–not true. 4 ways to deal with claims rejections pain

One of the pervasive and overlooked pains in claims management involves claims rejections. Claims rejections require the billing staff to review the claims, address whatever is missing or in error and resubmit the claims in order to get paid. In some cases, payers reject specific claims over and over again. What’s even more painful is that billers, with the best of intentions, sometimes will put the rejected claims in a file folder which, if not dealt with immediately, can collect dust. Are you feeling the throb?

  • Pay attention to rejections
  • Discover the issue and if it is something you can control, address and fix it quickly.
  • Check the contracts.
  • You may have to stop accepting certain insurances/payers.

3 unique ways to shorten revenue cycles

LTPAC CFOs in the 21st century have to be concerned about many things. But in reality, much of what CFOs do revolves around getting paid on time in the amounts anticipated. Perhaps paying attention to the not-so-obvious factors influencing payment may be worth investigating.

Three ways to shorten the revenue cycle by “developing and leading the finance team to maximum productivity and responsiveness”:

  • Improve A/R team job satisfaction
  • Address claims processing costs
  • Pay attention to Medicare Secondary Payer (MSP) claims

Claims Process

Topics: claims rejections POA POA indicator revenue cycle Present on Admission shorten revenue cycle
3 min read

No pain, no gain–not true. 4 ways to deal with claims rejections pain

By Prime Care Tech Marketing on Thu, Feb 11, 2016 @ 02:00 PM


iStock_000045792732_Small.jpgMy office is in my home. Occasionally, my wife will step up behind my chair as I am working on the computer and start to massage the back of my neck. Ow! All of a sudden I am aware of a throbbing pain I didn’t know I had. At first it REALLY hurts. In a short time, though, I feel the pent-up tension and throbbing dissipate and I begin to relax. At that point she stops, giving me a reassuring pat on the back. Released, I return to my task, but then I feel the tension begin to return and I have to ask myself, “What’s causing this?” Likewise, sometimes providers get so caught up in the busy-ness of business, they are not aware of some persistent pains which can impact effectiveness and even the bottom line. 

Pain does not necessarily mean gain

One of those pervasive and overlooked pains involves claims rejections. Claims rejections require the billing staff to review the claims, address whatever is missing or in error and resubmit the claims in order to get paid. In some cases, payers reject specific claims over and over again. What’s even more painful is that billers, with the best of intentions, sometimes will put the rejected claims in a file folder which, if not dealt with immediately, can collect dust in some forgotten file drawer. Are you feeling the throb?

What can providers do to minimize the pain of rejected claims? Here are some tips you can follow to limit the number of claims rejections:

  1. Pay attention to them. Look at a summary of your rejected claims for the month and sort it by payer and rejection reasons. (In your clearinghouse application, you may be able run a rejection status report and sort by payer.) Do you see a pattern? Are the majority of the rejected claims coming from a few payers? Are the rejections for the same reason? Are the rejected claims submitted by one or two of your new billers? Are these legitimate rejections or do you sense that the payer is simply dragging its fiscal feet?
  1. Discover the issue and if it is something you can control, address and fix it quickly. There can be a lot of money at stake. In some cases, the payer implemented a policy change and will no longer accept a specific revenue code. Find out what that code is and make sure your billers use the correct code. This may require a focused review each month before submitting claims to that specific payer to make sure the new policies are followed. If you have a new biller on staff, the errors may be traced to him or her. This can be a great training opportunity.

    In some instances, we have discovered that a billing requirement may be published for all payers to implement. However, a few hold-outs still want providers to follow the old policy. Know who they are and make sure your billers know about them too.
  1. Check the contracts. Some payers will reject claims containing specific diagnosis codes. The problem may not be that the diagnosis code is not compliant with the ICD10 coding requirement. The payer just may not cover such diagnosis codes. We emphasize again – know your contracts. Having a code on the clinical record is appropriate, but may not be so on the claim. Avoid billing for excluded diagnosis codes.
  1. You may have to stop accepting certain insurances/payers. Do certain payers repeatedly reject initial claims submissions for no apparently legitimate reason? Opt out if the payer seems to be problematic. That’s a pain that may require contractual amputation.

No pain, no gain? In fact, in the case of rejected claims, you can gain without the pain by following these tips. Track your rejections and pay attention to trends in billing errors or payer practices. Then take corrective action immediately. Doing so can be as good as a neck massage, because…it makes cents.

Topics: claims rejections billing staff
3 min read

What Billers Should Know to Help Jumpstart 2016

By Prime Care Tech Marketing on Wed, Dec 23, 2015 @ 01:48 PM

Billers 2016 ClaimsValuable highlights from 2015 blogs to prepare for 2016

Hard to believe that 2015 is rapidly passing into history. Another year, but what a year it has been for Long Term Post-Acute Providers (LTPAC) providers especially considering the incredible number of claims billers have had to prepare, submit, monitor, and manage. We congratulate billers across the country for what they have been able to accomplish in converting claims to cash in the bank.

The primeCLAIMS team works just as hard to provide an excellent clearinghouse service and also to communicate worthwhile tips and advice to help make billing tasks easier to complete. Looking back on our blogs in 2015, we have covered such topics as ICD-10, processing secondary claims, dealing with claims rejections, principles of successfully Revenue Cycle Management, tips for submitting clean claims, and what to look for in a LTPAC clearinghouse.

Regarding secondary claims, one of our recent blogs, entitled, “What you’re wasting by processing secondary claims manually,” discusses the why’s of automation. The days of manually identifying, preparing, processing, and tracking secondary payer claims is long past. If they haven’t already, we suggest billers retire such costly practices forever and start the new year right.

Managing claims does not have to be complicated we argued in the blog, “Do yourself a favor - Simplify the reimbursement process,” if billers automate the process.

Not all clearinghouses are created equal. In “How well is your claims management solution moving cash flow,” we share some insight into what a clearinghouse, processing LTPAC claims, should offer. Further, because no matter how automated the process may be, claims is still about people. And people and machines need support. In another blog, we ask the question, “Clearinghouse support – is it there when you need it?”

These blogs represent the kind of information billers and their managers should know to be successful not only in 2015, but also in 2016. We look forward to continuing to share our insights and the experiences of your peers in future blogs. After all, it just makes cents.

For your convenience, we’ve grouped the recent blogs by category:

Topics

Related blogs

ICD-10

ICD-10 – It’s here. Now what?

Maintain a solid financial footing through the quagmire of ICD-10 implementation

Secondary claims

Taking the Headaches Out of Secondary Claims

What you’re wasting by processing secondary claims manually

The Importance of Using a Clearinghouse for Secondary Claims

Rejections

How to handle claims rejections

RCM

Mitigate shrinking margins with revenue cycle management

Do yourself a favor - Simplify the reimbursement process

Simplifying the Managed Care Claims Process

It’s the Holidays! How to have financial Peace of Mind at this busy time.

Clearinghouse

How well is your claims management solution moving cash flow?

Clearinghouse support – is it there when you need it?

Clean claims

Giving Payers a Clean Claim – 11 tips to getting paid faster

Happy Holidays! May this season bring you and yours joy.

Claims Process

Topics: revenue cycle management claims management clearinghouse LTPAC, Long Term Post-Acure Care, ICD-10 claims rejections secondary claims clean claims LTPAC providers billers managing claims

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