From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing: Tips for Avoiding Denials Date:21 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives To provide information to the attendees that will allow you to reduce the number of denials you now receive from insurance plans/payers and pharmacy benefit plan managers/PBM’s

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 Preventing Denials It’s a Team Effort throughout the MTF Gathering of Patient Demographics CHCS Data Entry Provider Chart Documentation Record Coding General – Data Quality Ancillary Services Coding – Data Quality Coding Audits Provider Table Accuracy NDC Code Accuracy

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 Preventing Denials Gathering of Patient Demographics Patient Name Patient Date of Birth Patient Address Copy of Patient Insurance ID CARD – COPY Front and Back Insured Individual Name Effective Dates – Term Date

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 Preventing Denials Coverage Through? Employer/Retiree Plan Insurance Company Name Subscriber/Patient ---ID!!! – Many are not SS# any longer – HIPAA & many have a distinct number after for each individual covered by the policy Plan Code Group # RX BIN # CLAIMS Filing Address – RX vs. Medical

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 Preventing Denials CHCS Data Entry – Verified Information only – OHI/SIT new Classifications accurately entered – Occupational Visits – not billable –special MEPRS – Accident Case – Now - Block 11 of DD Form 2569 New DD Form 2569 this block will no longer be present

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 Preventing Denials Documentation – clinical – Provider documentation of ALL services rendered – Coding Audits – Pre-Billing – Statistical reports – Education and Training

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 Preventing Denials Coding – General – Code only what is documented – Audit and Educate – 24 hour stays – Inpatient/outpatient overlaps

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 Preventing Denials Coding – Ancillary Services – Be Specific – Utilize data from Civilian Ordering Physician Request it if not provided – Reflect actual service not general – CPT Code Book Annually update deletions and additions

2007 UBO/UBU Conference From Registration to Accounts Receivable 10 Preventing Denials Provider Tables – Specialty – Non Privileged Provider vs. Privileged Provider – DEA Codes – License #’s – HIPAA Taxonomy – NPI #’s

2007 UBO/UBU Conference From Registration to Accounts Receivable 11 Preventing Denials NDC Items – Frequency of Updates – Ownership of Updates – Expired items – Zero $’s – NO RATE – Days Supply and Quantity – CHCS Conversion table issues

2007 UBO/UBU Conference From Registration to Accounts Receivable 12 Preventing Denials Most Frequent Denials – Non Participating Provider – Medicare EOB Required – Unable to identify patient as subscriber – Duplicate Claim Ancillary care not linked can cause this

2007 UBO/UBU Conference From Registration to Accounts Receivable 13 Preventing Denials Front End Impact on Back End A/R Functions – Incorrect data Cause payer denials Cause claim rejections Cause slow down in payment Cause payers to question credibility of future claims

2007 UBO/UBU Conference From Registration to Accounts Receivable 14 Preventing Denials Front End Impact on Back End A/R Functions (Cont’d) – Insufficient data Cause payer denials Cause claim rejections Cause slow down in payment Cause payers to question credibility of future claims – Staff frustrations – Leadership questions

2007 UBO/UBU Conference From Registration to Accounts Receivable 15 Preventing Denials Communicate and educate your partners – Leadership of MTF – Providers – Check-In Personnel – Coders – UBO/PAD Office – Payers & PBM’s (Pharmacy Benefits Managers)

2007 UBO/UBU Conference From Registration to Accounts Receivable 16 Preventing Denials Communicate and educate your partners (Cont’d) – Make suggestions – Partner with your TPC/OHI staff – Provide Briefings on outcomes and impacts – Monitor when changes are to be made – Provide Feedback on weakness and SUCCESS

2007 UBO/UBU Conference From Registration to Accounts Receivable 17 In Summary T = Top down support needed for best outcomes to be achieved E = Everyone has a part in providing data for claims submitted A = A/R overall is affected by the accuracy of claims data M = Money in the bank with less denials and more claims paid as submitted

2007 UBO/UBU Conference From Registration to Accounts Receivable 18 Quiz W ho owns accuracy of Data on claim? O ne of the most common reason for denials? R eason for performing pre-billing coding audit? M onitor out comes and statistics, why? S hare the success with whom?