Billing: Focus on front-end processes

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Wednesday, January 8, 2020
Dawn Chapman

Q. Denials are putting a burden on cash flow. How can I quickly improve my denial rates?

A. Denial follow-up uses valuable resources that could be better utilized in other areas. The good news is that 75% of denied claims are recoverable. More good news is that an even higher percentage are preventable. Suppliers tend to be reactive to denials and the sheer number can be overwhelming. The goal should be to prevent the denials instead of wasting resources with research and resubmissions. Focus should be placed proactively on front-end processes, thus speeding cash flow. It is necessary to have knowledgeable staff (whether in-house or outsourced) that can review information and make informed decisions before your equipment is delivered. There are three simple processes to focus on to see immediate improvements.

Documentation review

When you receive an order, your intake specialist must have the knowledge to determine medical necessity based on payer guidelines.  These denials are difficult to correct after the claim has been billed.

Eligibility verification

Demographic information must be checked thoroughly.  Your intake specialists must investigate to determine eligibility and coverage.  Time is wasted billing incorrect payers or billing for items the patient doesn’t have coverage for. 

Prior authorization/reauthorization

Very few payers will issue a retroactive prior authorization. It is vital for staff to be knowledgeable about what services require prior authorizations. There also must be a process in place to identify orders that need reauthorizations.

Audit your processes for documentation review, eligibility verification and prior authorizations. These tasks are often rushed through for the sake of providing better customer service. Maintaining a well-trained staff and creating a workflow with focused review at critical points will ultimately reduce your denials and increase cash flow.

Dawn Chapman is owner of Chapman DME Billing. Reach her at dawn@chapmandmebilling.com.