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Optimizing Billing Practices Billing Claims Self Assessment

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Optimizing Billing Practices Billing Claims Self Assessment

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    1. Denial claim analysis Webinar Monday, March 29, 2010 Optimizing Billing Practices Billing Claims Self Assessment

    2. Your presenters Presenter Stephanie Ceponis, Lead Site Financial Analyst 213-386-5614 ext. 4534, ceponiss@cfhc.org Moderator Chuck Marquardt, Director of Training 213-386-5614 ext. 4583, marquardtc@cfhc.org

    3. Tools you can use – Feedback Toolbar

    4. Floating Toolbar Use the floating toolbar to communicate in today’s session.

    5. Q&A

    6. Polling There will be times during the presentation that we want to hear from you. We will open a short poll and ask you to choose your answer to the questions posed. After we view the results, we will need for you to close the polling window by clicking the minus sign in the upper right corner of the panel. We will remind you again when we get to that place in the presentation.There will be times during the presentation that we want to hear from you. We will open a short poll and ask you to choose your answer to the questions posed. After we view the results, we will need for you to close the polling window by clicking the minus sign in the upper right corner of the panel. We will remind you again when we get to that place in the presentation.

    7. Webinar etiquette All phones are muted. Questions can be asked via chat throughout the session or raising your hand in WebEx. Lines will be opened at the end for additional questions.

    8. Objectives The participant will be able to do the following: Complete the Excel workbook, CFHC Billing Claim Denials Analysis; Analyze data to identify problem areas in billing claims; Describe plans of action for a variety of possible denial scenarios.

    9. What are we going to learn? How to utilize the CFHC denial analysis tool . Some common denial codes and the key pieces to review to help reduce the frequency of the particular code. Action plans – ways to reduce denials.

    10. Rejects & Denials Poll #1 Does your agency work or follow up on rejected or denied claims as part of standard practice? Yes No Polling question – wait for participants to give some answersPolling question – wait for participants to give some answers

    11. Rejects & Denials Poll #2 Has anyone analyzed the rejects and denials to see where they are coming from? Yes No Polling question – wait for participants to give some answersPolling question – wait for participants to give some answers

    12. Rejects & Denials Poll #3 What is a common denial code your agency receives? Write in your response to the right of your screen. Polling question – wait for participants to give some answersPolling question – wait for participants to give some answers

    13. Rejects & Denials Poll #4 What is the purpose of rejects and denials? Write in your response to the right of your screen. Polling question – wait for participants to give some answersPolling question – wait for participants to give some answers

    14. Start thinking… Poll #5 What can we do to eliminate or minimize the number of rejected claims? Write in your response to the right of your screen. (click for main bullet points)(click for main bullet points)

    15. Start thinking… Poll #6 Which group in your agency originates the most rejects? Clinicians Front desk/receptionists Eligibility workers Billers Multiple sources (click for main bullet points)(click for main bullet points)

    16. What You Will Need All RADs from 6 months or less. A Staff person to enter data. This does not have to be a biller, and could be administrative staff. 10 – 20 hours of data entry time, depending on the number of claims submitted. (click for each main bullet point)(click for each main bullet point)

    17. 5 Simple Steps The Billing Claim Denials Analysis can be completed in 5 simple steps: Collect data Enter data Analyze data Create a plan of action Implement the plan (click to start the steps)(click to start the steps)

    18. 5 Simple Steps The Billing Claim Denials Analysis can be completed in 5 simple steps: Collect data Enter data Analyze data Create a plan of action Implement the plan (click to start the steps)(click to start the steps)

    19. 5 Simple Steps The Billing Claim Denials Analysis can be completed in 5 simple steps: Collect data Enter data Analyze data Create a plan of action Implement the plan (click to start the steps)(click to start the steps)

    20. The Analysis Tool

    21. Overview of the Analysis Tool An Excel workbook with 5 sheets Summary denials sheet Data entry with some formulas RAD denial data sheet Data entry tab where the “meat” of the denials gets entered RAD denial summary sheet Populated from RAD denial data tab – no data entry unless you need to customize (click for each round bullet point)(click for each round bullet point)

    22. Overview of the Analysis Tool Chart Data table is on RAD denial summary tab Collection Report Data entry (click for each round bullet point)(click for each round bullet point)

    23. Summary Denials Worksheet

    24. (after review of this slide, flip to the actual workbook)(after review of this slide, flip to the actual workbook)

    25. Recap – Summary Denials Worksheet Enter data in cells A through F. Cells G, H and I use formulas. Gives you summary data for the whole RAD not just denials. (click through bullet points)(click through bullet points)

    26. RAD Denial Data Worksheet

    27. (after review of slide, flip to excel workbook)(after review of slide, flip to excel workbook)

    28. Recap – RAD Denial Data Worksheet Enter data from RAD into cells A, B, D, E and F. Only one denial code can be entered into cell G. A number “1” must be entered into cell H for each completed row.

    29. RAD Denial Summary Worksheet

    30. (after review of slide, flip to excel workbook)(after review of slide, flip to excel workbook)

    31. (after review of slide, flip to excel workbook)(after review of slide, flip to excel workbook)

    32. Recap – RAD Denial Summary Worksheet All information is populated from the RAD denial data sheet. No data entry is needed unless customizing the denial code list. If customizing, remember to copy the formulas from prior cells.

    33. 5 Simple Steps Get the data Enter the data Analyze data Create a plan Implement the plan

    34. Pie Chart

    38. Collection Report Worksheet

    40. Analysis Tool Recap Summary denial and RAD denial data worksheets are the primary data entry sheets. RAD denial summary worksheet does not have any data entry unless you need to customize the denial codes. Data table for chart is already formulated – chart will automatically be created from data entered. (click through bullet points)(click through bullet points)

    41. Tips to reducing the number of rejected and denied claims Common Denial Codes

    42. RAD #0117 This procedure is payable only twice per month Ongoing education and counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider

    43. RAD #9518 The referring provider must be a Family PACT certified provider The referring Doctor must provide their NPI# to the rendering Doctor to be reimbursed on Family PACT services. The NPI# must be in correct field on claim form.

    44. RAD #0315 Recipient information on claim does not match eligibility information on file for this person Verify the name, sex code, date of birth and client’s ID #

    45. RAD #9655 The frequency limits for this procedure have been exceeded. Resubmit claim with documentation indicating medical necessity for the test Verify if the frequency limit has been reached prior to rendering services Lab reservation must be made via the Laboratory Services Reservation System (LSRS) with NPI Claims must be billed with same NPI reservation was made under

    46. 5 Simple Steps Get the data Enter the data Analyze data Create a plan Implement the plan

    47. Planning Staff training Change how information is collected Change the superbill Get specialized training

    48. Possible Changes Staff training regarding the completion of the Client Eligibility Certification form. Modify the superbill to reflect only those procedures your agency provides. Clearly separate what is in-house lab versus outside lab. Perform quarterly chart billing audits.

    49. Possible Changes Create a daily chart review prior to billing. Create clear steps to rectify questions prior to billing. Provide training to clinicians regarding coding.

    50. Resources: Family PACT www.familypact.org http://familypact.org/en/Providers/policies-procedures-and-billing-instructions.aspx (PPBI, Provider Bulletins, Superbill)

    53. Resources (cont.) Medi-Cal www.Medi-cal.ca.gov http://files.medi-cal.ca.gov/pubsdoco/billing_tips.asp (Provider manual, Bulletins, CMC info)

    58. 5 Simple Steps Get the data Enter the data Analyze data Create a plan Implement the plan

    59. Questions????

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