| What SCARES a CFO? NO CASH |
Collect all cash that is due the organization, minimizing denials and streamlining processes. Seems so simple, it's scary. Listed below are a few core Revenue Cycle principles.
- Leadership that leverages staff productivity
- New technology to create new best practices
- Improve existing technology
- Establish coherent and effective processes
- Measure, trend and report outcomes
- Effectively track outsourced accounts
- Measure Cost to Collect
- Assure billed claims are paid with one claim submission
- Optimize Follow Up collections technology and staff time
- Improve accuracy of registration, coding and documentation
- Education of staff
- Clear and concise up-front collection processes, charity care and communication
- Establish strict guidelines for compliance and CDM processes
- Systemize managed care contract rates and variances
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| Denial Dilemma |
Timely Filing-Managed Care contracts require a proof of timely filing, example the documented date a claim is mailed hard copy. How do you provide this proof of a mailed date? Some options: There are vendors that deliver daily reports of claims mailed by postal service which can be automatically uploaded to your host system. If you are a small organization manually key the dates for each claim mailed for proof and send those high dollar accounts via certified mail or use another carrier such as FedEx... Electronic claims sent have a computerized date stamp that is easy to capture and provide to any payer.
Other Payer Rejects-For rejects based upon failure to meet medical necessity requirements or the submission of duplicate claims, look into using an internal list of codes to quantify and qualify denials. Share the denial reports with other departments outside of PFS and benchmark progress in fixing revenue integrity or medical necessity issues. The use of technology identifies issues which can then be written to report events, categorizing and prioritizing issues.
Underpaid Claims-Calculate expected payments before the payer sends payment. Document A/R system with expected payment. Technology is a key component in the identification of underpaid claims. Measure and Report underpaid claims. Example: one payment pattern may reveal that every claim paid by a single payer is being underpaid by $25.00 and there are thousands of those claims. This would be worthwhile to rebill and pursue these payments.
CIGNA Denied Claims
Proper instructions of how to appeal or resubmit claims to CIGNA based on the type of denial incurred. Don't let the payer win this game and deny monies owed. Beat them at their own game and win the denial game!
"WHAT GETS MEASURED GETS MANAGED" |
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Medicare Billing |
SURGICAL ERROR: Bill NO-PAY CLAIM
Effective October 5, 2009 for FIs and Part A MACs for services rendered after January 1, 2009.
Hospitals must submit two claims to Medicare whenever a surgical error is reported on an Inpatient claim along with a covered service.
1. Claim with covered services UNRELATED to the error
2. Claim with services RELATED to the error as no-pay
Outpatient and Practitioner claims must submit:
-Applicable HCPCs with appended modifiers to lines
that are related to the erroneous surgery/procedure.
Criteria: surgical or other invasive procedure to treat a medical condition when the practitioner erroneously performs:
1. a different procedure altogether
2. correct procedure, wrong body part
3. correct procedure, wrong patient
Medicare will not cover hospitalizations and other services related to those non-covered procedures.
Beneficiary Liability
Provider cannot shift financial responsibility to the patient for the non-covered services UNLESS the ABN or HINN is provided to the patient, which CMS cannot envision a scenario in which these forms could be delivered prior to the error, except for possibly follow up care.
CMS MedLearn Matters 6405
Billing for the Influenza A (H1N1) Virus Vaccine
Effective September 1, 2009 CMS has created two new HCPC codes.
G9141 Administration (includes the clinical counseling)
Payment rate same as G0008
Revenue Code 771
G9142 Vaccine, any route of administration
Payment rate is $0.00 to provider
IF billed on claim add a $0.01 to line item for
claim to pass Medicare edits.
Appearance of G9142 not required on claim
for payment of G9141-DO NOT BILL PATIENT
for this line item service
**Office visits will not be paid by MAC, if this is the only reason for patient visit.
+++These HCPC codes should be used for Medicaid & Commercial claims.
####All other type of influenza vaccines should not use these HCPC codes above.
Version 5010 Inbound 837I Institutional and Inbound 837 Professional Flat Files Implementation
Effective January 1, 2010
CMS is continuing with their implementation of the HIPAA version 00510. The purpose of this transmittal is to implement the version 005010 837I and version 005010 837P flat files. Jurisdictions J1,J3,J4,J5,J10,J13 and J14 are instructed to prepare their systems to process ASC X12 version 005010 837 transactions by January 1, 2010.
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| Tricare Billing and Reimbursement
October 1, 2009 |
Inpatient acute care hospitals that are paid under the Tricare DRG payment system will be required to report a 'present on admission' (POA) indicator for every diagnosis on inpatient acute care hospital claims. This policy change is effective for admission on or after October 1, 2009. Report POA indicators in accordance with the NUBC and ICD-9-CM guidelines.
Tricare will deny any claim from a non-exempt facility that does not report a valid POA indicator for each diagnosis claim. Tricare Reimbursement Manual here | |
$210 BILLION ANNUALLY is a staggering number.
BOO! This is a scary fact recently printed by Price Waterhouse Coopers who reports that INEFFICIENT CLAIMS PROCESSING adds up to $210 BILLION annually.
Cirius solutions provide a SUPERIOR CLEAN CLAIM electronic solution. CHANGE is evident immediately with INCREASED CASH and ENSURED COMPLIANCE. Every day extract DOLLARS and value in solving billing problems, prevent technical claim denials, collect ALL dollars due with a SUPER RESPONSIVE business partner that SUPPORTS YOU!
Contact Regional Account Executives:
Northwest and Midwest: mark.ehnen@ciriusgroup.com
Southwest and East: dougs@ciriusgroup.com
Happy Halloween,
Jayne Kroner
VP, Business Development
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Electronic Transaction Standard Code Sets |
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837 Health Care Claims
834 Enrollments
270/271 Eligibility for health plans
835 Remittance advice/cob
820 Health plan premium payments
276/277 Claim status/attachments
278 Referral/Certification/Authorization
148 First Report of Injury
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Compliance |
The department of Health and Human Services has released the forms for hospitals to use in submitting information to HHS about breaches of a patients' unsecured medical information. HIPAA-covered entities must notify the HHS secretary by electronically submitting the breach report form via the HHS Web site. If a breach affects 500 or more individuals, covered entities must notify the secretary concurrently with the individual notice to affected individuals. If a breach affects fewer than 500 individuals the covered entity may notify the secretary of such breaches on an annual basis. Reports of breaches affecting fewer than 500 individuals are due the secretary no later than 60 days after the end for the calendar year in which the breaches occurred.
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| Case Study |
FREE Revenue Cycle Webinar
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Billing Tip: Death Certificate |
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An original death certificate must be used to report or notify Medicare of a patient's death. Often this form is difficult to obtain. Usually a death certificate may be obtained from the patient's family members but if this is not possible then a certificate may be obtained at either a local state Department of Health or county records office in the county or state patient died. |
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AAHAM ANI
Phoenix, Arizona
NETBOOK WINNER Katie Hughes, Manager of PFS, at Augusta Medical Center
Join Cirius at a future EVENT |
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| Press Release |
| Please join me in welcoming these new clients to the Cirius family.
Sutter Health
Intermountain Health
Billings Clinics & Hospital
Scripps Health System
Allow us the opportunity to provide the RIGHT TOOLS in building a Revenue Cycle or Reimbursement framework with best practice technology available today. Contact us; we want to share our story and our customers' stories. |
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| Revenue Integrity |
| The new crest of the wave for change encompasses the revenue cycle process functions including charge capture, accurate codes for claims, data mining & reporting, internal chart and bill audits, performance improvement initiatives and coding and billing compliance regulatory oversight. Other functions that may be included is case management and utilization review. | |
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