| Denial Management
Increasing revenue is a top priority. When every delayed or
denied claim has a direct impact on your bottom line, it becomes
increasingly important for you to secure accurate patient
data and eligibility information upon admission. Collecting
the right information at initial contact speeds reimbursement
and eliminates wasted efforts looking for missing information
after services are rendered.
Denial management is a growing concern. Practice expenses
are increasing at an alarming rate while reimbursement is
flat or declining. Today’s challenging healthcare environment
requires a level of expertise that few can provide. Superior
Health Care Management can help you meet these challenges
with the experience and expertise in billing management services
that have made us a leader in the industry.
Often claims are denied because of simple errors, such as
incorrect billing codes or claims sent to the wrong payer.
Superior Health Care Management helps you quickly uncover
and correct the problems that lead to denials — by allowing
you to review and research payer denial trends, correct and
resubmit rejected claims.
Our Denial Analysis Report will help understand the problems
related to past-due receivables and determine payer trends,
thereby providing an opportunity to address systems and processes
at a global level.
» Data Overview
» A/R Analysis by Location
» A/R Analysis by Payer
» Denials Break-up
» Summary & Recommendations
» Glossary of Terms
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| Opening Balance for March |
$ 1,856,878.88 |
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| Gross Charges |
$ 1,009,538.50 |
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| Net Collections |
$ 502,135.71 |
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| Contractual
and Bad-Debt Write-off |
$ 471,106.15 |
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| Closing Balance
for March |
$ 1,893,175.52 |
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| Dates of Service |
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| Follow up
Dates |
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| Receivables Addressed
( in dollars) |
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| Receivables
Addressed ( in Claims) |
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| Locations
L & M reflect a high denial rate in areas related to additional
information, Authorization and Eligibility suggesting a need
for improved front office support & training.
Locations L & M reflect fair high coding related denials.
Improvements may be needed in the coding departments.
Locations L & M need to verify Managed Care Contracts
and Local payor behavior patterns. High denial rate with Capitations
and Non-Covered Services.
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Summary
& Recommendations
It has been identified that most of the denied and pended claims
are due to problems related to the front-office, coding department
and claims submission. These denied or pended claims are a result
of invalid or insufficient information, incorrect coding practices
and poor performance by the clearing-house or a lack of follow-up
at the claims submission level. The outcome is a loss of revenue
to PQR through delayed payments, delay in payments and overall
inefficiency.
» Re-format registration
sheet to collect all necessary information
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Provide monthly reports to physicians on dollars pending
due to poor front office performance.
» Monitor rejection rate with clearing-house.
Re-visit claims submission process, safety
nets and actions steps for rejections.
» Provide
training for front-office staff on insurance specific requirements. |
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Addl Claim
needs Additional Information
Auth
Claim requires Prior Authorization (Excludes Pre-Certification)
Bun Payment
bundled in another procedure
CAP
Provider has a capitated arrangement with
insurance
CNOF
Claim not on insurance records.
Need to re-file.
COB Coordination
of Benefits – Patient may have other coverage.
Coding
Any denial related to Coding
Practices excluding Bundling.
Dup Duplicate
Claim. Claim already received and processed.
Elig
Patient coverage not active on the Date of
Service.
Non Cov
Service not covered by Plan.
UT
Service
exceeds limitation on Utilization.
Other
Any denial not within the scope of those mentioned above. |
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| While providing
services of over a decade to numerous physician & groups
we have benefited by observing and learning from many different
systems and billing methods. From these experiences, we have
fine-tuned our billing and reimbursement management services
into one of the most productive systems being utilized in the
industry. Superior Healthcare
Management a leader in Oncology, Radiation &
Chemotherapy billing services can help you with entire practice
work flow and claims management processes. Our Billing Center
eliminates unnecessary claim denials and delays through a complete
integration of workflow, billing and reimbursement management.
Clean claims are submitted the first time every time thus increasing
your cash flow.
Our Billing professional, coders and staff are in constant
contact with payors, hospitals, patients and your practice
to ensure claims are sent & paid on time.
Our rules are constantly updated by Specialty and State. Our
Coders have online access to CCI edits, LMRP and Fees Schedules.
We offer long term services that are often more effective
and less expensive than "in-house" options. Our
services allow you to benefit from an ensemble of highly skilled,
trained, and specialized professionals, without the risks
and costs of full-time employees. |
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Outsourcing Benefits include:
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accelerate your cash flow
»
increase your AR collections
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increase your productivity
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enhance your patient relations
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improve your workflow while reducing work load
» compliance
with third party payors
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optimize leading technology |
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Below are
some of the services we provide to providers:
Eligibility
verification services are available within Superior
Healthcare Management based upon payor specific capabilities
and access.
Our fee schedule management
provides a detailed account of the true accounts receivable
for the practice. It also provides an easy visual assessment
of the variance between the scheduled payment amount and actual
payment made by the payor.
Our AR Management
resource we can help you earn the money you deserve. Our experienced
staff can assist you in turning your aged receivables into cash
and increasing your bottom line without increasing overhead
and staff.
Our Denial Management
helps determine where deficiencies lie in coding and billing
practices. This tool is used for providers to correct coding
and billing errors up front instead of correcting the claim
when denied. This helps to ensure claims are "clean"
when filed to the insurance company. |
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Why
Superior 
