Physicians Practice - January 2008 - (Page 55)

But wait, there’s more: A signiﬁcant number of rejected claims are in fact due to miscoding. That’s something a good claims-auditing program also can help you with. “We are a group of podiatrists and . . . podiatry does have its quirks, like every specialty,” says Perchick. “There are speciﬁc modiﬁers and qualiﬁers that need to be on it’s usually because the carrier wants more documentation, or some other reason that couldn’t have been anticipated by the practice. • Explanation of Beneﬁts Analysis — It’s critical to understand why your claims are denied in the ﬁrst place. To do that, you need a system that can comb through all of your denied claims and sort them “We were on a practice management system that really kind of tied our hands as far as being able to run reports that were effective. … You had to do each and every single claim as an individual report. When you have a practice this large, that is very difficult.” A BUMBLING BEHEMOTH Joan Bryan, practice administrator things for DME [Durable Medical Equipment] and need to be on claims for routine foot care and other speciﬁc things.” Perchick’s group would routinely submit claims without the appropriate modifying codes, which resulted in not only a denial but also a 30-day setback in the collection process. A claim-scrubbing program can compare the CPT or ICD-9 codes and send up a ﬂare at spots where a modiﬁer may be missing. More robust programs apply complex algorithms that compare the code against a patient’s age, the diagnosis, and other factors to see if it makes sense for the claim. Florida Heart Group extols the beneﬁts of using a scrubber. “Claims that go out now are probably anywhere from 95 to 98 percent clean,” says Bryan. When claims are denied, WWW.PHYSICIANSPRACTICE.COM according to physician, diagnosis, billing code, and payer. With this more in-depth analysis, you might uncover some surprising problems, such as a physician who habitually under-documents or miscodes patient encounters, or an insurance company that processes certain claims incorrectly. “[Analysis] gives you important data for contracting and for working with your proprietor rep,” says Nicoletti. “Sometimes everything you have done is right; it’s just that the payer can’t process it.” Bryan likes the ability to run reports on individual users. “You can quantify the amount of work that your staff is doing, and you can see where there are differences from appointment scheduling to working claim batches,” she says. Certain software companies even let you compare JANUARY 2008 | PHYSICIANS PRACTICE | 55 http://www.altapoint.com http://www.altapoint.com http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - January 2008

Physicians Practice - January 2008 Contents The Bigger Picture: Fixing Medicaid Letters Physicians Practice Pearls: You Can Teach an Old Dog New Tricks Noteworthy Cover Story: Fee Schedule Survey: 2007 Results Adding Ancillaries: Bucking the Practice Ask the Experts Idealab: 'How I Got Over My EMR Excuses' Technology: Don't Be Denied The Tech Doctor: Blessing or Curse? The Administrator's Desk: Learning From the Best Coding Career: To Partner, or Not? Management: Controlling Your Inventory Human Resources: How to Fire an Enployee Finance: Beyond Reimbursment - How to Fix Your Mix Classifieds Advertiser Index

Physicians Practice - January 2008

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