#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 [email protected]
.
.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
.
.
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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?
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. .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
Need Help?
Thank you!
Look out for our email, containing the webinarrecording and a free eBook