9 Ways to Reduce ASC Claims Denials
About 5 percent of ASC claims are denied by the insurer during the first review, according to Kelly D. Webb, CEO of ASC Billing Specialists in Glendale, Ariz. Here Mr. Webb provides nine best practices on how to reduce your denial rate.
1. Analyze what is being denied. Look back on six months of denials and track the explanation of benefits. Generally, 30-40 percent of denied claims are improperly denied.
2. Challenge each denial. As a general rule, the wording of the insurer's denial is not totally accurate. So you need to call them on each denial. Their own codes may not reflect the true cause of the claim denial.
3. Match payments with contract. Make sure the payment matches with the expected amount set by the contract. Match the allowable amount with what the ASC was actually paid.
4. Be certain payment rates are up-to-date. Make sure you update your software with the current correct coding initiative edits.
5. Collect the right patient information. Have procedures in place to ensure the right patient information is entered. Everyone is focused on mistakes in the billing office, but it could be the front office has entered incorrect information. Staff should copy the front and back of the patients' insurance identification and copy the front of the driver's license.
6. Make a record of the prior authorization call. To verify the call, you can often obtain a call reference number, linked to the insurer's recording of your particular call. If not, ask for the first name and last initial of the person you talked to. Always record the date and time you placed the call.
7. Understand primary and secondary insured. If the patient's spouse is the primary insured, then the spouse's name and date of birth need to be reported on the UBO4 or CMS-1500 form sent to the payor.
8. Re-review claims before they are sent. Print out the claim on white paper and have two or three people review it for errors and typos such as transposed names and the wrong date of birth.
9. Review transmissions from claims clearinghouse. When the claims clearinghouse scrubs the claims you submit and finds errors, it returns those with errors. These "kickbacks" need to be corrected and resubmitted. Billing personnel at some ASCs don’t know what to do with them and simply set them aside, untended. The billing manager should review all kickbacks and ask billing personnel how they dealt with each one.
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