Great question by Jordan T.. I agree with Cissy M., reason codes aren’t the same as denials, and sometimes “denials” aren’t real denials. If you submit a claim, follow all your processes, and see that the claim will be denied for frequency, then the patient pays up front and you submit a claim with zero dollars expected. In that example, you’ll receive a reason code, but you were expecting zero, making the “denial” not a real denial. The PMS is the only place you can see your expected amounts for your procedures. Submitting your UCR and expecting zero dollars is not a denial. The reason code might be “Frequency”, but it is not a real denial. A few thoughts when it comes to choosing an RCM product if you want accurate RCM reporting: 1. A connection to the PMS is paramount. This is why it is so important that DSOs demand interoperability as Arna Meyer stated. 2. Without a PMS connection you can’t “see” expected amounts, making denial analysis inaccurate, because you can’t tell which codes you expected to be zero dollars and which you expected a payment. 3. DSOs are going to drop to paper for some payors. Is it 1%, 5%, or 10%? Each office is different, but if you’re only dependent on one source of data, in this example the Clearing House, you will have holes in reporting. Jordan T. at InsideDesk we don’t “negate zero balances”, but we can see the procedure code expected payment and don’t include that as a “denial.” Let me know if there’s anything we can do to help, friend.
Once upon a time when I was a Practice Administrator, I remember getting an email about how we needed to work on our “avoidable denials” AKA frequency denials. I was confused because I always had my team check frequencies and history prior to presenting any treatment plans. I asked for a list of claims that had been denied for frequency, because I assumed it had to be a lot for me to be talked to about it. As I checked each account, they all had $0 balances. The frequency "denials" had already been anticipated and the costs were explained to the patients and we collected up front. 💰💰💰 We still billed the insurance, as you're supposed to. Sometimes data doesn't tell the whole story. Has anyone found any RCM/reporting solutions that are able to negate $0 balances in the denial analytics/reporting? Are we seeing true PMS integrations where we could track that? #rcm #claimmanagement #revenuecycle #denials Eric Gallegos Andrew McMath Whitney Ehrlichman Sina S. Amiri Manuchehr K. Dr. Ali Saad Tanner Applegate Teresa Williams, M.L.S. Devan Gillespie Jenny Fetty InsideDesk Zentist Harold Gornbein Gavi Cohn Felicia Furlong, MHA Arna Meyer
Lindsay Romeo
3mo
I agree
Data Nerd 🤓 | Dental Tech Advisor 🚀 | PMS Poweruser 🦄 | AI Enthusiast | Product Superfan
4moThank youuuuu! 🥰 Can’t wait to see your updates in action. 👏🏻 You can help by just continuing to do what you’re doing.