Wecare Billing, LLC

Denial Management is the process of identifying, analyzing, and resolving denied claims in medical billing. Here's a detailed overview: Steps in Denial Management: 1. Denial Identification: Recognize denied claims through claims tracking, payer notifications, or patient inquiries. 2. Denial Analysis: Investigate the reason for denial, including:    - Reviewing claim details and supporting documentation    - Verifying patient information and insurance coverage    - Identifying coding, billing, or compliance errors 3. Denial Categorization: Classify denials into categories, such as:    - Medical necessity    - Coding or billing errors    - Authorization or eligibility issues    - Timely filing or submission errors 4. Denial Resolution: Take corrective action to resolve denials, including:    - Correcting and resubmitting claims    - Appealing denials with supporting documentation    - Obtaining additional information or clarification from payers    - Educating staff on accurate billing and coding practices 5. Denial Prevention: Implement measures to prevent future denials, including:    - Updating billing and coding guidelines    - Enhancing staff training and education    - Improving claims scrubbing and editing processes    - Conducting regular audits and compliance reviews Key Performance Indicators (KPIs) for Denial Management: 1. Denial Rate: Percentage of denied claims out of total claims submitted. 2. Denial Resolution Rate: Percentage of resolved denials out of total denials. 3. Appeal Success Rate: Percentage of successful appeals out of total appeals filed. 4. Denial Turnaround Time: Average time taken to resolve denials. 5. Revenue Recovery: Amount of revenue recovered from denied claims. Effective denial management reduces revenue loss, improves billing efficiency, and enhances patient satisfaction.

Medical Billing and AR Insights Did you know that: - The average medical practice writes off 10-20% of its revenue due to billing errors and inefficient AR management - The top 3 reasons for medical claim denials are: 1. Incorrect patient information 2. Insufficient documentation 3. Lack of medical necessity - Implementing a robust AR management strategy can reduce bad debt by up to 50%. Stay tuned for more insights and tips on optimizing your medical billing and AR processes! #medicalbilling #accountsreceivable #revenuecyclemanagement #healthcare #medicalpractice

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Medical billing common interview questions 1. Tell me about yourself. 2. Why did you apply for this job? 3. What are your areas of expertise? 4. As an AR agent, what is denial reason code 96 5. What is denial reason code co-226. 6. What is denial reason code co 197 7. What is medical necessity? 8. What is pre-authorization? 9. What is denial reason code CO16 10. What is CLIA certification 11. What is the place of service for doctor's office 12. What is RCM in detail? 13. What is a rendering provider 14. What are annual deductibles for medical professionals and institute 15. What is HIPPA law and when was it issued 16. Type of providers 17. Where we enter the Authorization number in CMS1500 18. What is the current version of ICD codes 19. What are bundled procedures 20. What is a global period 21. What are the modifiers for E&M codes 22. What is a QW modifier 23. What is a W9 form? 24. How many times a year does Medicare pay for wellness visit 22. What is a PTAN number 23. Where we add NPi for referring providers in CMS1500 25. What are mutually exclusive procedures Share any questions you had in your mind #rcm #denialmanagement #interview #medicalbillingservices #Aging #billingexperts #billing #providers #providers #providercredentialing

Here’s some tips to keep your AR below 120 days and some tips on managing those above 120! 1. Always make sure your denials and rejections are being addressed as soon as you are notified there is an error. This needs to be a part of your billers day to day tasks. And that all new claims are submitted with 24-48 hours max. 2. For claims approaching 120 days be sure to follow up on claim status if you haven’t received any communication on them. A lot of times this means calling insurance payers to check the status. 3. Review claims that are over 120 days monthly. This is where you make the decisions on how to move forward with each. Reviewing these month will help you identify trends, if any, that are delaying reimbursement. 4. Don’t put off admin tasks like write-offs or sending to collections on accounts not moving. It will add up and can get messy quickly. Be sure to address these types of decisions every month. If you see your AR over 120 days increase you know there is a process or human error issue in your revenue cycle. Be sure to intervene as quickly as possible to avoid timely filing and missing out on revenue. How often do you review your revenue cycle as a business owner? #medicalbilling #physicians #nursepractitioner #privatepractice #credentialing

In medical billing, #denials are when insurance companies refuse to pay for certain medical services or treatments, often due to errors or lack of coverage. Here are some #common_denials in #Medical_Billing along with their corresponding denial codes: 1. #Missing_incomplete_invalid information**: Claim lacks necessary information or has errors. - Denial Code: #CO_16 2. #Duplicate_claim_service**: Duplicate claim submitted for the same service. - Denial Code: #CO_18 3. #Service_not_covered_by_payer**: Service is not a covered benefit. - Denial Code: #CO_22 4. #Expensive_or_luxury_items_services**: Service/item is considered expensive or luxurious. - Denial Code: #CO_25 5. #noncovered_charges**: Charges not covered under the patient's benefit plan. - Denial Code: #CO_96 6. #Timely_filing_exceeded**: Claim not submitted within the payer's specified time frame. - Denial Code: #CO_29 7. #Billing_error**: Claim submitted with incorrect information. - Denial Code: #CO_31 8. #Services_not_authorized_by_payer**: Services not pre-authorized as required. - Denial Code: #CO_33 9. #Charges_exceed_contracted_rate**: Charges exceed the contracted rate with the payer. - Denial Code: #CO_45 10.#Payment_adjusted_because_of_the_quality_based_procedure_protocol**. - Denial Code: #CO_50 It's important to check with the specific payer for the most up-to-date and accurate information regarding denial codes, as they can vary between payers. #denialmanagement #Denials #rcmservices #medicalbillingservices #rcm #growth #copied #share #ushealthcare #ushealthcarerecruiter #connect #connected