Every practice wants to receive payment for claims in a timely manner. When payment moves past the 30 day mark, it can represent a cash flow issue at the very least—and potentially lost revenue in the worst case.

When I took over as practice administrator at Arkansas Allergy and Asthma Clinic three years ago, I inherited a lot of backlogged claims. With two dedicated billing staff to handle more than 60,000 claims each year, we all had to make a commitment to whittle away at our aging accounts receivable (A/R).

Read More ›

Thank you to everyone who joined us on November 3 for our latest webinar, Increase Revenue – Take Your Appeals to the Next Level. During the one-hour event, industry expert  Tammy Tipton, president of Appeal Solutions, the leading denial management training and resources company, discussed how to easily customize your appeal letters for Level II appeals; use carrier appeal form letters most effectively; and address poor quality appeal review.

To learn more about how your practice can improve your appeal letters process and improve your revenue cycle, click here to download the webinar recording.

This program meets AAPC guidelines for 1.0 Core A or 1.0 CPCO specialty CEUs. On Demand product requires successful completion of a Post Test for continuing education units.

Are your appeals letters designed for maximum mileage? Medical organizations send detailed, persuasive appeal letters every day. Despite these well-written efforts, many appeal letters result in “Denial Upheld.”  This is not the end of the road, but rather a case for Level II appeals.

Join us on Thursday, November 3 at 1:00 pm EDT, for a free webinar: Increase Revenue – Take Your Appeals to the Next Level. Register Now.

During this hour, you’ll hear industry expert, Tammy Tipton, president of Appeal Solutions, the leading denial management training and resources company, discuss how to:

• Easily customize your appeal letters for Level II appeals – ensure that none of your higher level appeals are rejected due to “no new information.”
• Use carrier appeal form letters most effectively – payer-specific appeal customizations can make a significant difference.
• Address poor quality appeal review – you have the right to request a review by higher level personnel.

Don’t let a denied appeal become a write-off. Take your appeals to the next level.

Participants can earn 1.0 Continuing Education Unit (CEU) from the American Academy of Professional Coders (AAPC) by attending.

Register Now. 

After 18 years managing all aspects of the revenue cycle within the healthcare industry, I’ve noticed many practices often submit claims to insurance companies only to later receive a denial because they didn’t include a key element that the payer requires—an element they didn’t even know  had to be included. In frustration, the practice fixes the issue and resubmits the claim, then moves on to the next claim. This effort costs valuable time and delays cash flow. But what have they learned?

The key to effective cash flow is to really manage denials, not just resubmit claims. In today’s healthcare environment, it’s important for practices to avoid examples such as the one above by taking just a little time to understand claims processes from the payers’ perspective. After all, payers don’t decide the care a patient should receive. Their role is simply to: 1) identify what they will reimburse, and 2) set guidelines for how they will reimburse.

Read More ›

As manager of collections and reimbursement for Radiation Oncology Services of America (ROSA, Inc.), I am constantly thinking about ways to enhance the collections process and speed up reimbursement. Although there are many good practices worth considering when trying to improve the reimbursement process, the following are a few I’ve found to be most beneficial:

• Foster good relationships with front end staff. Our organization has a centralized billing office that works claims for all of our 16 radiation therapy locations. This means that we at the billing office are geographically separated from the clinics with which we work. Because of this, it’s critical we maintain a good working relationship with front end staff based on mutual respect and effective communication. That way, everyone is on the same page about what is needed to support a clean, efficient, and successful claims process. For example, a good working relationship helps ensure that front desk staff understand the importance of collecting and sending accurate patient demographic and insurance information. Read More ›

When a claim is denied, one of the first questions you should ask yourself is whether prior authorization was obtained for the services listed on the claim. If the answer to this question is “yes,” then you have to dig deeper to determine why it was denied—and how to prevent such denials in the future.

Unfortunately, claims with prior authorizations are denied more often than you might think. There are five common reasons for these denials that you should take into account and ways to avoid them:

Read More ›

Imagine you are driving a Ferrari at top speed through the Italian countryside. What is the last thing you want to see? Speed bumps! That’s what it feels like when you have to deal with claim rejections – it slows down your revenue. In addition, using staff time to fix and resubmit those claims can be a slow process – especially when your office is already pressed for time.

So how do you avoid these “speed bumps?” The first step is to identify which rejections are occurring most often and which are more than just a one-time occurrence. One of the easiest ways to start this analysis is by running a report through your clearinghouse’s software. If your clearinghouse does not offer this option, you will have to manually go through rejection reports and analyze them by hand.

Read More ›

In today’s complex world of healthcare billing, practices can make some common—yet costly—errors that lead to incorrect billing, denied claims, and lost revenue. The good news is that many of these mistakes are avoidable with some adjustments to process, approach, and training.

Mistake 1: Incorrect data on the front end. This error often involves inaccurate patient demographic/insurance information or invalid insurance coverage. The main culprit: lack of verification. The best way to avoid this type of mistake is training, training, and more training! Staff responsible for patient check-in should be educated on the importance of collecting appropriate information and verifying insurance, as well as specific steps to accomplish these tasks. (Ideally, these processes should occur before the date of service to identify potential problems early, and to ensure patients understand their fiscal responsibilities.)

Read More ›

Customer service is a big deal for ACT Health Management Services. We pride ourselves on offering quality client service to the 65-70 providers that make up ACT Medical Group of Wilmington, N.C. We expect the same dedication to service from our vendors, but unfortunately we haven’t always received it. In fact, lack of good customer support was one reason we left our former clearinghouse. We wanted a system with more robust and better functionality, as well as a business partner that would take our unique challenges as seriously as we do.

In 2010 we decided to go live with a new clearinghouse at the same time that we adopted an electronic health record (EHR). With two implementations going simultaneously, we discovered firsthand just how valuable a teamwork approach can be. When the inevitable snags delayed parts of our EHR installation, for instance, we ended up going live with our clearinghouse’s Electronic Remittance Advice (ERA) feature before we had any place to store the data. The situation could have been a nightmare, but it wasn’t. Our clearinghouse was supportive throughout the process, helping us develop the necessary “workarounds.”

Read More ›

This is the first in a series of articles that will answer some commonly asked questions about different aspects of the revenue cycle.

Today, more than ever, practices are focusing on ensuring they have a strong revenue cycle – this includes making sure denials are minimized and appealed when appropriate. Today, we are answering some of the most commonly asked questions about denied claims and the appeals process:

Read More ›