#CureMDWebinar @Ken_Edwards01

Road to ICD-10 Part II

Stop Fighting Denials!

Presenter

Ken EdwardsSenior Billing Manager, CureMD

Webinar #1: Review

In our previous webinar in ‘The Road to ICD-10’ series, most attendees

opted to go for the ICD-10 conversion on their own

The results:

What is your strategy for ICD-10 so far?

Poll results (single answer required ):

44%

31%

25%

Go at it alone

Outsource to a billing company

Bring an ICD-10 Consultant on board

ICD-10 Does Change EVERYTHING

Statistic /Matrix

Denial Rate

Claim Error Rate

Claim Turn around

Coding Speed

DenialManagement

15%

3%

45 Days

Varies depending on

proficiency of your coder

Nonclinical person

Increase 100 %

6 – 7%

55-75 days

Increase by 18 minutes

on average

Clinical Input Required

Current ICD-9 Environment

Post ICD-10 Projections

Quick Poll

What is your average monthly claim denial rate ?

Do you have a Denial Management Strategy Post ICD-10 ?

Focus Areas

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.

.

.

Evaluating Denial Management Preparedness

Clinician role in denial prevention and defense

Resources devoted to coding support

Strategic deployment of technologies

Focus Area -1

Evaluating your Denial Management Preparedness

Questions to ask Yourself

Have we completed a chargemaster review?

Have we reviewed all our contracts withour payers?

What is our strategy to minimize documentation burden on physicians?

How are we retro�tting our report infrastructure to monitor denials?

How many educational sessions have been held for ICD-10?

Are we engaging not just rank-and-�le medical sta�, but also physicians?

Have we aligned and assigned budgets fordenial management activities?

Have we reviewed our Revenue Cycle Matrices ?

How many educational sessions have been held for ICD-10

Physician’s Role post ICD-10

Physician participation in denials management will

need to increase under ICD-10

Focus Area -2

.

.

Be aware of the depth and types of

documentation they will need to provide

before claims processing

Add clinical perspective and input when

denials occur

Tip # 1 :

Conduct a Comprehensive documentation gap analysis

What are you missing ?

Disease type is not documented

Disease acuity is not documented

Documentation not found at all

Site specificity is not documented

Disease stage is not documented

Laterality is not documented

One or more details for a combination code

.

.

.

.

.

.

.

Tip # 2 :

Minimize Documentation BurdenDeploy Medical Intelligence or templates that guide physicians on required

documentation

Let someone else do the typing for them! Physicians should concentrate on

the quality of information only.

Talk to Joe Martin for CureMD Discrete Transcription Services at joe.martin@curemd.com

.

.The Remedies Pros Cons

Hire a scribe Professional Cost & time

Dictation software Cost effective Not discrete

Transcription service Cost effectiveDiscrete

Time effective

Resources for coding support

Focus Area -3

Consider employing a full-timephysician as head of denial management or contracting withclinical specialists

Pinpoint a person to track and trend denials; someone accountable for contacting the insurance plans, making necessary corrections, and resubmittingclaims.

Make sure that every department is on board with the changes in their workflow for ICD-10.

Strategic deployment of technologies

Focus Area -4

The claims denial system your practice uses today may no longer be sufficient post ICD-10

Clearing House

Prior Authorizations

Claims Scrubber

Claim Status

Portal

ERA

Referrals

Payment

Analytics

Eligibility

.

.

.

8% of total claims submitted are rejected due to eligibility issues

Auto EligibilityVeri�cation

Credit Card Payment Facility

Front Desk

Checks Deductibles Co-pay collection Coinsurance

Collect Patient Responsibility. Post ICD-10 even a small leakage in your

revenue stream will have a huge impacton your practice.

Link: Patient Collections: 7 mistakes your practice should avoid

Automatic Coding

Seamless data exchange

Integrated EMR & PM solution

In-built in most Practice Management

Systems

Clean Claim Checks

Catches more than 98 % of errors. Runs

thousands of rules on each charge

within 5-7 seconds.

Advanced Claim Scrubber

Multiple payer solution

Trending data on denials and under payments

Clean claims

HIPAA Compliant

The Right Clearing House

Medical billing departments

Clean Claim Checks vs Claim Scrubbing

Claim Scrubber Clean Claim Checks

Available on the charge page

Checks formats and validity of insurance policies

Educates on correct coding by suggesting corrections

Ensures �eld completenessEnsures CPTs & ICDs are entered correctly

Have to check individually in the incompleteclaims section

Ensures CPTs & ICDs are entered correctlyt

Claim ScrubbingVSClean Claim Checks

A pre-claim submission tool in your application

Identifies errors prior to claim submission

Eliminates manual claim checking

Reduces claim rejections & denials

Improves turnaround time by 8-10 working days

Ensures all claims get paid in the first go

......

How does a claim scrubber help?

Claim

NCCI (Comprehensive & Mutually Exclusive)

Local Coverage Determinations

Insurance Policy Format Checks

Address Validation

EDI File Structural, Claim Level Edits

Gender & Age Restrictions (CPT & ICD Checks)

Updated CPT & ICD-10 Libraries

Medicare Member ID Gender & Age Suffix Checks

Claim Level Dates

Taxonomy Codes Validation

Waived CLIA Number Validations

CLIA, NDC, DEA Format Checks

............

What does it check?

Advanced Claim Scrubbing is the Secret Ingredient to CureMD’s

RCM Service Success !

The results:

Consider Outsourcing!

50% increase in efficiency (lesser billing hours)

97.8% of claims reimbursed on first submission

Faster reimbursements

Insurance Turnaround – 15 days or less

Minimum manual effort

Client Retention Ratio : 99 % Practices are happy with our Medical Billing Services

Case Study CureMD

.....

Intrigued ?

Who can use a Claim Scrubber?

.

..

..

. .Practices Billing companies Practice Management Vendors

Scrubber for CureMD Users

Scrubber for non-CureMD Users

Simple integration

Incorporated into the application within 2-3 business days

Upload Claim �les to CureMD’s scrubbing portal

Integrate Scrubber into your Practice Management System via API*

Quick Poll

What area would you like us to cover in the next webinar of the

Road to ICD-10 series?

Session

QA&

Request a demo to see how CureMD can facilitate

your practice for ICD-10

Get in touch with our billing experts

at (212) 852 0279 ext 381

For further inquiries regarding

Claim Scrubber, send us an email

at wayne.henderson@curemd.com

Need Help?

Thank you!

Look out for our email, containing the webinarrecording and a free eBook