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Tracking Payer Rejections After 5010 Goes Live

In the great TV series “M*A*S*H,” the character Radar could hear incoming helicopters carrying wounded soldiers from a long distance away  and he would yell “Incoming!” as they were getting close to the hospital. Well, the 5010 launch date is January 1, 2012 and all I can say is…. “Incoming!” Hopefully, most practices have been working diligently with their technology vendors, so they do not anticipate a large volume of new payer rejections when 5010 is implemented. However, it’s still a good idea to have your ‘radar’ ready and know how to quickly spot these rejections if they do occur.

The first step is to spot new rejections that you have not seen before. Assuming you use a clearinghouse, you will probably have access to data detailing each rejection category and rejection message. In this case, you can easily compare the top rejection messages for January 2012 to the previous few months. You should be on the lookout for any messages that are new – these can be easily spotted because the previous months will have zero rejections for that message.

The second step is to spot any significant increases in existing rejections. This task will be slightly more challenging, but still feasible. Using your clearinghouse “trending” data, you should be able to see the total number of each type of rejection by month. If you export the data to Excel, you can calculate growth for each rejection and then sort by the largest percentage increase. You will want to pay close attention to the totals because a rejection’s volume could grow from 1 to 2, which is a 100% increase. If this occurs, it’s probably just a blip on your radar.

The final step is to see which payers have significantly increased their rejection rate for January. If your clearinghouse has the capabilities to sort rejection rates by payer, this will be easy. Once you have this information, you can look at the rejection rates for January and then compare it to the previous months’ rates. If you see a spike in the rates, you should be concerned.

Each of the analyses above is a mini radar that can help you track payer rejections in the 5010 world.  You can use these tools for the first few months of 2012 to watch payer rejections and make adjustments in your processes as needed. Start preparing now by using these methods and practicing how you will spot new rejections or increases to existing rejections. With a good early warning system at your command, you will not be caught off guard!