How RCM companies helps hospitals to get Down Coded Claims ?

Do you know what healthcare professionals look for? Timely and fair payments! Down-coding is a threat to feasible billing practices. RCM companies for hospitals help get paid for the down-coded claims with extraordinary billing practices followed by professionals. The insurance companies feel it takes time to analyze if the services are accurately performed. Sometimes, it’s acceptable that the level of service for few diagnostic codes does not match the E&M codes.

The insurance companies started to down-code these claims and lowered the reimbursement for the professionals. It continued after several reviews and was unable to expect the claims to be paid right after flagging. Apparently, healthcare professionals also feel that the insurance companies perform down-coding to pay less and save revenue.

This article elaborates how RCM companies for hospitals help get paid these down-coded claims with no much difficulty.

RCM companies for Hospitals play wonders with documentation

  • As simple as that, firstly, RCM companies for hospitals will concentrate on the claims from the beginning of the process. Your documentation process will have to be presented neatly and meticulously.
  • Necessary or required documentation that justifies the E&M service prevents the down-coding or denial. Systematic documentation acts as the key to the claim of getting paid right and appropriately.
  • When the level of service gets missing from the patient’s record, it means it was not done in the first place. If there is a check-off sheet to fill during the visit, you can cut off this error.
  • However, let’s not make it so complicated. You can make it easy after creating a template that can serve the purpose.
  • It additionally also keeps the healthcare professional reminded about the E&M service level to be recorded.

Help from the Billing & Coding Team

  • Stay in touch with the medical billing and coding teams. Let them get back to you when some codes are supposed to be changed and when they feel something goes missing.
  • Medical billing and coding teams must be efficient enough to identify the mistakes and have an eye for detail. In case of suggested changes, sending a memo by a coder simplifies the process.
  • Even before the insurance companies, the task might get accomplished. If a copy of the coding section is also attached to the memo, things are easier to track for the physician.
  • Medical billing and coding teams discuss with each other and help to rectify the errors before submitting the claims.

Track the Pattern

  • Tracking the pattern of denials and down-coding is another strategy.
  • Medical coding and billing teams in RCM companies for hospitals will need to track the reasons for down-coding and denials.
  • If some codes of services are denied persistently, then it is the place to sort things out.
  • For example, if patient information is not appropriate, the claim numbers are not right, or the identification numbers are going wrong, it is repeatedly seen as the reason for rejection. It helps you cut the problem off.
  • When there’s no reason, insurance companies’ down-coding is for no good reason, and then it is time to contact the payer regarding the same.
  • You aren’t alone in this. In the case of down-coded claims and lesser reimbursements, few groups like local and state medical societies and hospital-physician organizations actively fight against unfair down-coding.

Filing Error Free Claim

There are five ways to avoid rejected claims just because the coders haven’t got the hang of the ICD 10 coding system.

How to Manage Underpayments:

  • A common technique to end up underpayments is assuming that all the patients know about EOB. Looking into the situation is the best solution to this issue.
  • The processing problem can also be often solved by explaining how the claims get underpaid and why it takes so much longer to get paid.
  • The patients will have information to share that comes in handy. RCM companies for hospitals won’t take hours to check if the patient has changed the contact information or the insurance company since the last visit.
  • You can’t expect the patients to be proactively providing the information. Office staff might find it difficult, and yes, this detail that takes a few seconds to ask for can positively affect denials.

Practice Management Software is Crucial:

  • Before getting to the point, you wouldn’t know it unless you thoroughly read the medical codes and the denial reasons.
  • Run through them and identify the exact underlying cause. If you see a major percentage of claims rejected for the same reason, then you have the solution right in front already.
  • If your hospital billing software is unable to pull the required data, again, you must know it is time to upgrade your software.

Use the updated hospital Billing Software:

  • Ensure if your software is up to date. Changes in ICD codes have also caused some changes in the software. Contact the billing software company if you feel it has not been updated.
  • It is not enough that the updated software is used, but the RCM companies for hospitals that use it should be educated on any changes and comfortable using the same.

Read and Proofread:

  • At least 50% of the time, you can rule out ICD 10 rejection with ease, and provided you pay attention to the claims.
  • Before claim submission, ask your office staff to read and proofread to identify potential errors.
  • In case there are confusions or complexities involved with the codes to be used, or if the entries seem unsatisfying, this strategy helps rule out all chances of going wrong with the codes.
  • A clean claim submission brings down chances of rejection and getting delayed payments.

Educate your billing staff:

  • Train your staff on the ICD 10 codes and transitions. Continuous training should be given to ensure there are no errors committed.
  • If you require improving the revenue flow, your focus should be on educating the office staff. The right way to hit the rejection is to ensure who enters the codes, starts the billing process, and is aware of the changes.
  • When you are not concentrating on the ways to reduce ICD 10 coding mistakes, your claim denial percentage keeps growing, and the payment delays are on the cards. Preparation and training can do out most rejections.

Outsourcing the claims to RCM companies for hospitals can significantly help in improving the revenue rates. Denials and rejections can go out of the question. All you need is to choose the right one that fits your business.

To learn more about billing and coding, please subscribe to our blog. You can follow us on Facebook, Linked In, and Twitter to find more videos on healthcare. Please write to us in the comment box to connect with us.

Comments are closed.