Stop Fighting Denials!

Road to ICD-10 Part II

@Ken_Edwards01

#CureMDWebinar

Presenter

Ken Edwards
Senior 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 ):
Go at it alone

44%

Outsource to a billing company

31%

Bring an ICD-10 Consultant on board

25%

ICD-10 Does Change EVERYTHING

Statistic /Matrix

Current ICD-9
Environment

Denial Rate

15%

Increase 100 %

Claim Error Rate

3%

6 7%

Claim Turn around

45 Days

55-75 days

Coding Speed

Varies depending on
prociency of your coder

Increase by 18 minutes
on average

Nonclinical person

Clinical Input Required

Denial
Management

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

. 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
How many educational sessions have
been held for ICD-10
ICD-10?

How are we retrofitting our report

infrastructure to monitor denials?

Have we completed a chargemaster review?

Are we engaging not just rank-and-file

medical staff, but also physicians?

Have we reviewed all our contracts with

our payers?

Have we aligned and assigned budgets for

denial management activities?

What is our strategy to minimize

documentation burden on physicians?

Have we reviewed our Revenue Cycle

Matrices ?

Focus Area -2

Physicians Role post ICD-10

Physician participation in denials management will
need to increase under ICD-10

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 specicity is not documented
Disease stage is not documented
Laterality is not documented
One or more details for a combination code

Tip # 2 :

Minimize Documentation Burden

.
.

Deploy 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.
The Remedies

Pros

Cons

Hire a scribe

Professional

Cost & time

Dictation software

Cost eective

Not discrete

Transcription service

Cost eective
Discrete
Time eective

Talk to Joe Martin for CureMD Discrete Transcription Services at joe.martin@curemd.com

Focus Area -3

Resources for coding support

Pinpoint a person to track and trend
denials; someone accountable for
contacting the insurance plans, making
necessary corrections, and resubmitting
claims.

Consider employing a full-time

physician as head of denial
management or contracting with
clinical specialists

Make sure that every department is on board with

the changes in their workow for ICD-10.

Focus Area -4

Strategic deployment of technologies

The claims denial system your practice uses today may no longer be sufcient post ICD-10

Clearing House

Scrubber

Claims

ERA

Eligibility

Prior Authorizations

Payment
Portal

Referrals

Claim Status

Analytics

Front Desk

8% of total claims submitted are rejected due to eligibility issues

Auto Eligibility
Verification
Checks
. Deductibles
. Co-pay collection
. Coinsurance

Credit Card Payment

Facility
Collect Patient Responsibility. Post
ICD-10 even a small leakage in your
revenue stream will have a huge impact
on your practice.

Link: Patient Collections: 7 mistakes your practice should avoid

Medical billing departments

Integrated EMR & PM solution

Advanced Claim Scrubber

Automatic Coding

Catches more than 98 % of errors. Runs

Seamless data exchange

thousands of rules on each charge

within 5-7 seconds.

Clean Claim Checks

The Right Clearing House

In-built in most Practice Management

Multiple payer solution

Systems

Trending data on denials and under payments

Clean claims
HIPAA Compliant

Clean Claim Checks vs Claim Scrubbing

Clean Claim Checks VS Claim Scrubbing

Claim Scrubber

Clean Claim Checks

Ensures CPTs & ICDs are entered correctly

Ensures CPTs & ICDs are entered correctly
t

Ensures field completeness

Available on the charge page

Have to check individually in the incomplete

claims section

Checks formats and validity of insurance

policies
Educates on correct coding by suggesting
corrections

How does a claim scrubber help?

..
..
..

A pre-claim submission tool in your application

Identies 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 rst go

Claim

What does it check?

..
..
..
..
..
..

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 Sufx Checks
Claim Level Dates
Taxonomy Codes Validation
Waived CLIA Number Validations
CLIA, NDC, DEA Format Checks

Advanced Claim Scrubbing is the

Secret Ingredient to CureMDs
RCM Service Success !

Case Study CureMD

The results:

..
..
.

50% increase in efciency (lesser billing hours)

97.8% of claims reimbursed on rst submission
Faster reimbursements
Insurance Turnaround 15 days or less
Minimum manual effort
Consider Outsourcing!

Client Retention Ratio : 99 % Practices are happy with our Medical

Billing Services

Intrigued ?

Who can use a Claim Scrubber?

Practices

Billing companies

..

Practice Management Vendors

Scrubber for CureMD Users

Simple integration
Incorporated into the application within 2-3 business days

.
.

Scrubber for non-CureMD Users

Upload Claim files to CureMDs 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?

QA
&

Session

Need Help?
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
at wayne.henderson@curemd.com

Thank you!
Look out for our email, containing the webinar
recording and a free eBook