Top Medicare Denials

Noridian Medicare just released last week the top five denials for October through December.

The top five are:

Non covered because the service is not deemed medically necessary
The procedure code or modifier was invalid for that service date
Claim denied as patient can not be identified
Claim lacks the NPI of the referring or ordering physician
or NPI is invalid
Maximum benefits for time period have been exceeded

The Part B newsletter can be found at the link below:

https://www.noridianmedicare.com/provider/updates/docs/top_claim_submission_errors_Oct-Dec.pdf

What is more shocking, is that all of these reasons are easily preventable. By simply checking benefits and eligibility four of them can be eliminated and there are NPI look ups through NPPES.

We'll go more in depth on how to solve these denials in future posts or for tips on how to eliminate these denials in your office, give us a call, we'd love to help!

The A-Z revenue cycle, why it doesn't work.

I remember years ago there was a commercial, I think for an investment banking firm that claimed they “make money the old fashioned way, they earned it”. Well if you are following up on outstanding a/r balances the old fashioned way, you could be losing it. It used to be that offices would print out an a/r report and then start calling on balances from A-Z. It was quickly apparent that no one ever gets to “Z”. I have even had a coworker whose last name starts with “Z” exclaim how fun he thought it was to berate offices when they would call him about a balance months after the fact. They’d be so embarrassed at their inefficiency they’d write it off. Offices thought they got smart when they would work the report in reverse every other month to make sure that "Z" got 'worked' at least every 60 days. You can imagine how happy this would make the people with last names staring with “L”. In todays world an efficient office should have a turnaround time of less than 60 days, many offices have turnaround times of 45 days or less. Often this is referred to as “days in a/r”, and is a measurement of the average time it takes from the date of service to receive payment. Anything over 60 days and you should be identifying workflow issues in your office and implementing solutions to resolve them. If you need help with your revenue cycle, give us a call, we love this stuff.