“It is annoying and very time-consuming, but it is very important to appeal denied claims,” she said. “Insurance companies count on providers not pursuing appeals — only 35 percent of providers do. Yet many times appeals can be successful, so they’re worth the time.”
She recommended ASCs watch outgoing claims for common reasons for denial. For example, if the patient ID/subscriber number is incorrect, the provider’s signature is missing, the required dates are missing or the provider tax ID number is missing or incorrect, payors can deny an ASC’s claim easily and bank on the fact that most don’t pursue appeals. If claims are not being filed in a timely manner — within 12 months for traditional Medicare and tighter timelines for Medicare HMO — ASCs should speak to their billing staff to figure out where the problem lies.
She also gave several tips concerning billing that ASC administrators might not know. “When physicians list codes on operating reports, coders should still review the entire report to confirm the codes given are correct,” she said. Don’t assume that everyone at your facility is as knowledgeable as you would like, she recommends. Double-checking claims will help catch mistakes that even seasoned professionals make.
Ms. Ellis is an accomplished speaker and gives seminars around the country on billing, coding and reimbursement issues, claim denials, specialty coding and revenue cycle, among other topics. Before starting Ellis Medical Consulting, she worked as the operations manager of a national case management services placement firm and served as case manager, utilization review nurse and director of quality assurance for a statewide homecare agency. She also managed reimbursement for a national outpatient cancer treatment center and worked with Medicaid for three years as a coding specialist and fraud investigator.
Ms. Ellis earned her nursing degree from Belmont University in Nashville in 1981 and her CPC coding certification in 1999.
