5 Essential Tips to Improve Your Account Receivables and Avoid CMS Claims Denials

Improve your Accounts Receivable under new CMS guidelines, and avoid expensive, lengthy claims denials and appeals with these simple tips, from experts in Medicare accounts receivables and independent contractors for Part B. Clearing up your A/R metrics spreadsheet can be as simple as…

  1. Ensure all patient information, including insurance information, is entered correctly into the computer. Triple-check it. One of the most common problems with A/R and claims denials is actually one of the easiest to fix. Incorrect patient information entered, whether it is a misspelled name, wrong DOB, or insurance number typo, will all lead to claims being denied for that patient, which even with just a few cases can cause A/R to spiral out of control. Double- and triple-checking patient info as it goes into the computer system, though it may feel redundant, could save you thousands of dollars, and top billing consultants say it’s one of the biggest A/R problems they see.
  2. Always provide sufficient documentation, signed, with the correct date of service and place of service. Insufficient documentation is one of the most common reasons for claims denials, especially in evaluation and management (E/M) coding. Problems with documentation to watch out for: documentation that actually supports a different level of E/M than was billed for, lack of physician authentication, and wrong place of service. Lack of physician authentication means it lacked the physician’s signature. Please, please avoid this common pitfall. That’s just embarrassing.
  3. Don’t get caught up in “Double Jeopardy.” Note that you can either submit an appeal, or submit the claim a second time, but not both. Your appeal could wind up stalled indefinitely.
  4. New CMS guidance limits the scope of post-payment contractor audits. Good news, right? Well, be careful… Contractors now must only evaluate your appeal in light of the reasons behind the initial denial of the claim. So a solid appeal has a better chance of not getting rejected, especially since this takes the bite out of MACs and QICs to develop new issues with your case as excuses to maintain their denial. Law firms and the federal government both welcome this change in order to clear up legal backlog of appeals. But note that this only applies to post-payment reviews, and there’s a stipulation that denials/audits for insufficient documentation can only be successfully appealed if you demonstrate medical necessity for the services, not simply by sending in documentation.
  5. Be careful with bilateral procedures and repeat/duplicate services: When it comes to Medically Unlikely Edits (MUEs) and bilateral procedures, to avoid denials, you must code bilateral procedures as one item, one unit of service, with modifier 50 appended. Using multiple lines will get you past MUEs, but might land you with claim denials. These can be appealed without too much difficulty, but it’s not really worth the risk. Further, it is absolutely necessary to send supporting documentation and/or use modifiers to clarify when you’re billing for repeat or duplicate services, so it doesn’t look like overbilling.

Claims denials and audits can be awful for your accounts receivable, so implementing a rigorous system of checking and double-checking submitted documentation is well worth the hassle. Surprisingly many snarled A/R systems can be cleared up just by making simple changes and ensuring claims are fully documented. Documentation is a universe unto itself, however, so don’t get it wrong. I suggest you attend this session on “How to Improve your Accounts Receivables” by Elin Baklid-Kunz, a compliance expert with twenty years of experience in the field, and turn around messy A/R problems by ensuring a healthy practice.

1 Comment

  1. Great article!
    I do have a question on #4 “and there’s a stipulation that denials/audits for insufficient documentation can only be successfully appealed if you demonstrate medical necessity for the services, not simply by sending in documentation.” Since sending the chart note is not sufficient, are we to get a letter from the provider stating why he/she felt this was medically necessary or am I misinterpreting what you are stating?
    Thank you

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