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  • Coding Updates Revenue Cycle Management

    Refine Your Revenue Cycle: Denial Management Root Causes


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    A stack of denied claims left to be addressed “at a later date” can quickly add up to massive accounts receivable debt. Prioritize working denials quickly. Target denial management by identifying these common root causes.

    Registration Errors

    • Check for misspelled names, wrong birthdates, and incomplete insurance identification numbers.

    Timely Filing

    • Know your top payers’ defined filing period.
    • Track aging reports for outstanding accounts. Monitor them so that claims cross over to secondary payers promptly.

    Eligibility and Enrollment

    • Identify the primary payer when multiple insurances are presented.
    • Obtain current copies of insurance cards and confirm coverage and benefits prior to providing services.

    Prior Authorization

    • Confirm prior authorization requirements for all services prior to being performed. Failure to obtain required authorization does not automatically warrant the patient being responsible for the services.

    Incorrect Coding

    • Confirm coding is consistent with chart documentation and complies with each unique payer’s policy.
    • Verify that office visits, tests, and procedures meet Current Procedure Terminology (CPT) definitions, appropriate modifiers are appended, and covered diagnosis are linked to the correct line of service.
    • Do not apply one payer's guidelines to all payers.

    Education

    • Staff in all departments should have a comprehensive understanding of the top five payer specifications for the frequently performed services. Communicate any trends in claim denials to the entire team. When feasible have staff correct their own mistakes.