TOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE

Size: px
Start display at page:

Download "TOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE"

Transcription

1 TOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Billings & Reimbursements

2 Here are the Top Ten Metrics. The detailed explanations start on the following page. 1. Verification of Benefits/Collecting co-payments should be 100%. Top 10 Metrics to Maximize Your Practice s Revenue 2. Pre-Authorizations should be 100%. 3. Coding review and claim scrubbing should be 100%. 4. Clean claim submission rate should be greater than 95+% (best = 98-99%). 5. Denial rate should be less than 5%. 6. Accounts Receivables - 95% of your A/R should be paid within 60 days. 7. Your Adjusted Collection Rate should be 98 to 99%. 8. Accounts Receivable over 120 days should be less than 3%. 9. Reimbursement Ratio - Closed Claims vs. Overall Claims should be equal. 10. Negotiating Your Fee Schedule - 100% Optimization. A detailed explanation of these measures start on the next page. 2

3 The Top 10 Metrics to Maximize Your Practice s Revenue At MediGain our primary purpose is to help practices optimize their reimbursements and maximize their revenue. As a full service, professional revenue cycle management company, we have spent years working with a wide range of practices, specialties and hospitals. Here the Top Ten Metrics that we found that the most successful practices use to Maximize Their Practice s Revenue. 1. Verification of Benefits/Collecting co payments should be 100%. Believe it or not, it all starts at your front desk. Your staff should be using an up to-date, top tier, Practice Management System (PMS). They should use iverify, eeligibility or a similar system to automatically verify insurance coverage while scheduling the appointment. Then they can use this online system to check/double check the patient s deductible, co-insurance, co pay, etc. The key benefits from this best practice are to prevent lost/delayed revenue from billing the wrong insurance, and to arm the front desk staff with the information they need at the time of the patient encounter to maximize their cash collection of the patient s responsible portion of their encounter. 2. Pre Authorizations should be 100%. To prevent lost revenue from lack of prior authorization denials, it is essential that every procedure that requires pre- authorization is in fact preauthorized. The practice should utilize formal processes to ensure that all required pre-authorizations are performed at least 72 hours in advance of the procedure, and that emergency procedures are authorized within the required authorization window after the procedure. 3. Coding review and claim scrubbing should be 100%. Before submitting any claims, all procedure and diagnosis coding should be reviewed and scrubbed. Ensure that the ICD- 9CM, CPT, HCPCS codes and appropriate modifiers are billed. This will reduce the percentage of claims that are denied, delayed, or partially paid, and thus prevent lost revenue for the practice. Ideally, the coding review and scrubbing is performed by a combination of highly experienced and certified coders and highly sophisticated coding and claims scrubber software. A professional, full- service revenue cycle management company, like MediGain, has certified coders for specific specialties. 4. Clean claim submission rate should be greater than 95+% (best = 98-99%). Sending a claim which is complete and accurate the first time it is submitted is essential to increase cash flow, minimize days in accounts receivable, and prevent lost revenue from denied, delayed, or partialy paid claims. This will reduce the number of times that the Billing staff touches the claim. When reviewing your internal team or looking to outsource your billing, be sure to verify their clean claim submission rate. 5. Denial rate should be less than 5%. Technically, denials are claims that are adjudicated and rejected by the payer. Although there are specialty specific nuances, in general the best practices have an average of less than 5% denial rate when they submit their claims. The denial rate 3

4 is the percentage of claims denied by payers. (Some practices may measure this metric based on the percentage of charge line items denied.) The lower this number, the better a practice s cash flow and the less staff a practice needs to maintain that cash flow. Denied claims create the need for manual intervention, thus increasing practice costs, delaying payments and reducing revenue from any claims for which the denials are not timely and effectively addressed. A common problem with many busy practices is that many claim denials sit unworked since denials are usually the most difficult and time-consuming work for billing staff. Your revenue cycle management company should have a dedicated team assigned to handling denials and follow up, follow up, follow up. Average performers have a denial rate of 5 to 10%. Poor performing practices may have more than 10% of their claims denied on the first submission. To calculate your denial rate you should use a designated period of time (the last month, the last quarter, etc.). Then total the dollar amount of claims denied by your payers and divide that figure by the total dollar amount of claims submitted by your practice during that period of time. (Note: some use charge line items denied divided by total charge line items submitted.) If you would like to get into greater detail, do a denial rate analysis by payer, provider, remark code and/or category. A professional full service revenue cycle management company provides a dedicated team handling all the denials and follow up. Many in house billing operations tend to lack the expertise, sophisticated processes and software, and time to timely and effectively work all denials. In addition, many in house billers tend to avoid the hassle of following up on the smaller denials and only focus on the larger claims. However, if your in-house billing team does not follow up on several $20 claims each day, that equals a loss of over $10,000 from your bottom line each year. In addition, mistakes can be made in coding and charge entry. If your in house billers do not catch mistakes before they go out the door, it is costing your practice money. Metric #3 stated that 100% of your claims should be reviewed for proper coding and scrubbed to avoid denials. If your in house billing team or your billing and reimbursement provider do not review and scrub all your claims before they are submitted you should consider switching to a professional full service revenue cycle management provider. A professional full service revenue cycle management company with a dedicated denials team is a critical value- add to increase revenue and cash flow timeliness over most in-house billing operations. Work denials before the EFT is posted to the system. Report on top denials and provide feedback to your staff and providers 4

5 6. Accounts Receivables - 95% of your A/R should be paid within 60 days. This is a major factor regarding optimizing cash flow in your practice. If your practice has more than 5% of A/R greater than 60 days, you need to address these issues with your internal billing department or your billing service. Practices are often unclear about how to correctly calculate and analyze days in A/R. Days in A/R is a measure of how long it typically takes for a service to be paid by all financially responsible parties. The calculation features the outstanding money based on the practice s average daily charge. Days in A/R represents the average number of days that money owed to the practice are outstanding. To calculate days in A/R, divide your total current receivables, net of credits, by your practice s average daily charge amount. In order to net the credits, subtract the current credit balance (in effect, adding the balance because you are subtracting a negative number) from the current total receivables. For the average daily charge amount, divide total gross charges for the last 12 months by 365 days, representing the previous 12- month period. Depending on the specialty or certain circumstances some practices may find it beneficial to calculate their average daily charge on a three-month basis instead of 12. In this case, the previous three months would be divided by 90. The key is to make a choice, and use the metric consistently over time. Some important caveats: Specific insurance carriers whose days in A/R are higher than they should be: For example, if your entire practice s days in A/R is 44.95, but your Medicaid claims average 75 days, there is a problem with Medicaid that needs to be addressed. Make the same days in A/R calculation for each of your major payers so you can scrutinize the performance of all payers. If you don t break out days in A/R by payer, you may be missing potential trouble spots. The impact of credits: As noted in the calculation presented above, it is important to subtract the credits from receivables. Credits, money that is owed by the practice to other parties, actually offset receivables. Unless credits are treated correctly, a practice will get results that a skewed to the positive and you will not get a true picture of your practice s performance (not to mention regulatory compliance risks the practice may have as a result of not timely paying back credit balances). A recognition of collection accounts: For the majority of practices, accounts sent to a collection agency are written off the current receivables. Therefore, when calculating days in A/R, these funds are not accounted for in the equation. Submitting a large number of accounts to collections at once will cause your days in A/R to suddenly appear much better than they really are, so check what your team or provider is sending to collections. If they are sending a large amount of claims to collection right before you compute your days in A/R, this is a huge red flag. 5

6 7. Your Adjusted Collection Rate should be 98 to 99%. The adjusted (or net) collection rate is a measure of a practice s effectiveness in collecting all legitimate reimbursement. That is, it shows the percentage achieved out of the reimbursement allowed based on the practice s contractual obligations. This figure reveals how much revenue is lost due to factors such as uncollectible bad debt, untimely filing and other non contractual adjustments. A firm patient financial policy and billing protocol is necessary in order to achieve such a high net collection rate across the practice. One can look at just the insurance net collection rate, the patient net collection rate or the combination, but in any case there should be good patient billing practices in place to ensure those monies are collected to the fullest extent possible. Divide payments (net of credits) by charges (net of approved contractual adjustments) for a selected time frame. This calculation should be based on matching the payments to the charges that created them. This way, the practice avoids comparing charges generated in the current month with payments and adjustments taken on claims from many prior months (this can lead to great fluctuations in the results for this calculation). If your practice management system can t match payments with their originating charges, you should perform this calculation using aged data, typically from six months back, so it ensures a majority of the claims used for the calculation have had ample time to clear. To calculate the adjusted collection rate: divide payments net of credits by charges net of approved contractual adjustments, then multiply by 100. The total adjusted collection rate comes to a percentage. Additional caveats: Including inappropriate write-offs in the calculation of adjusted collection rate: Do not apply inappropriate adjustments to charges when posting payments - such as combining noncontractual adjustments and contractual adjustments together. Non- contractual adjustments must be appropriately designated, computed separately and placed in applicable categories indicating the reason, such as untimely filing, failure to obtain pre- authorization, and so forth. Tracking non- contractual adjustments based on their reasons will help reveal sources of errors and find opportunities to improve revenue cycle performance. Not having access to your fee schedules or reimbursement schedules for each payer: Without this data, you cannot truly know what you should have been paid. As a result, more inappropriate write offs may go undetected. 6

7 8. Accounts Receivable over 120 days should be less than 3%. Many practices are beginning to consider A/R over 120 days to be write offs. To calculate the percentage of A/R greater than 120 days, take the dollar amount of your receivables, net of credits, that is greater than 120 days and divide that number by your total receivables, net of credits. To calculate the percentage of A/R greater than 120 days, add together all the receivables in all the aging buckets greater than 120 days and divide that number by your total receivables (net of credits). For this metric, it is important to base your calculations on the actual age of the claim based on the date of service. 9. Reimbursement Ratio - Closed Claims vs. Overall Claims should be equal. This a measurement of two different collections ratios versus corresponding charges. A Closed Claim includes patient payment and full reimbursement from a Payor with any contractual adjustments made. The Closed Claim Ratio compares the Payor reimbursement and patient payment from claims matched exactly to the corresponding charges. The Overall Claims Ratio is the percentage of Total Revenue to every claim submitted, Total Charges, including those with any outstanding balance and all claims written off. These ratios when compared to each other should be as close to the same number as possible. A very well run practice may only have a difference of 1 deviation or less in this metric. 39% Closed Claims % vs. 38.5% Overall Reimbursement Ratio would mean that the practice receives almost all of their monies fully from Patients and Payors. A/R outstanding would be very low. If your Closed Claim Reimbursement Ratio is 39% and your Overall Reimbursement Ratio is 35%, the practice has 4% room for improvement of the Total Charges. This gives an improvement target for reimbursement overall at the practice. 10. Negotiating fee schedule. Of course you want to negotiate the best reimbursement rates because your time and skills are valuable. Here are four points to consider when negotiating your new contracts and help you get the contract rates you deserve: Average Paid Percent: Compute by dividing the sum of your payments by the sum of your submitted charges. This is just a gross collection rate that doesn t account for what the billed charge is or back out contractual adjustments. If you look at a gross collection rate, it will be greatly influenced by the billed charge amount. For example, a billed charge set at 200% of the Medicare allowable is quite different than one set at 300% of the Medicare allowable. The higher the billed charge is from the actual payment amount, the lower the gross collection rate. If a billed charge is set too low (such as 100% or even 125% of the Medicare allowable), the gross collection rate will look fantastic as it 7

8 would be close to 100% when in fact they may be leaving money on the table if the billed charge is set below some carrier allowables. It would also depend on the payer mix. In an ideal world, every claim you submit for payment would be paid at 100 percent. However, there are many reasons why this is not the case. Some examples include claim specific negotiated discounts, payment bundling, capitation, bad debt (ideally this would be below three percent) and previous payment discrepancies. For an average practice, the paid percent will be between 35 and 40 percent. The higher the percentage, the better your revenue will be. This depends heavily on the payer mix and fee schedule, since a good payer mix or low fee schedule will cause the paid percent to be higher, but the practice could still be losing a lot of obtainable revenue/reimbursement. (NOTE: You could use a net collection rate vs a gross collection rate as it negates the impact of carrier mix or billed charge amount - it boils it down to what percentage of the allowed amounts are being collected.) Medicare Allowable: You could use a percentage of Medicare allowable to compare the fees of different payers for different procedures to guide the identification of which payers and procedures to focus on for payer contract negotiations. Compensation for Top Procedures: This metric builds on average paid percent. Since you know the overall paid percent for each payer, you should consider how those payers are compensating you for your top procedures. If at all possible, sort your payments by procedure and by payer simultaneously. This will allow you to look at the top procedures for each payer and what their paid percent is for those procedures. This allows you to compare individual procedure payment rates between different payers. Average Reductions Percent: A payer s average reductions percent is the sum of the payer s contractual and other reductions divided by the sum of your submitted charges. This metric lets you determine which payers are consistently shifting more dollars than normal out of your payments and into contractual or other reductions (excluding patient responsibility). For the average practice, this figure is typically in the 47 to 53 percent range, but the lower the better. Again, this depends heavily on the payer mix and fee schedule, since a good payer mix or low fee schedule will cause the paid percent to be higher, but the practice could still be losing a lot of obtainable revenue/reimbursement. 8

9 ICD-10: Top 10 Things You Need To Do NOW! About MediGain Services, Inc. MediGain is a global full service revenue cycle management and healthcare analytics company devoted to improving billing, collections, and outcomes for healthcare providers and the patients they serve. With over 400 employees, MediGain provides solutions for physician groups, provider networks, ambulatory surgery centers and hospitals enabling them to reach their maximum potential through improved operational, financial, and clinical outcomes. For more information on how MediGain can maximize revenue, reduce expenses and allow you to spend more time on providing your patients with quality healthcare, visit call us at or marketing@medigain.com Dallas Parkway #200 Plano. TX

Sponsored by: Approved instructor

Sponsored by: Approved instructor Sponsored by: Approved About the Speaker Nancy M Enos, FACMPE, CPMA CPC-I, CEMC is an independent consultant with the MGMA Health Care Consulting Group. Mrs. Enos has 40 years of experience in the practice

More information

Billing and Collections Knowledge Assessment

Billing and Collections Knowledge Assessment Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open

More information

Billing and Collections Knowledge Assessment

Billing and Collections Knowledge Assessment Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open

More information

Driving Next-Level Revenue Cycle Performance: 5 Strategies for Physician Practices

Driving Next-Level Revenue Cycle Performance: 5 Strategies for Physician Practices Revenue Cycle Management White Paper Driving Next-Level Revenue Cycle Performance: 5 Strategies for Physician Practices Revenue cycle management (RCM) is the lifeblood of any physician practice and one

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

Unlocking and Using Practice Performance Intelligence

Unlocking and Using Practice Performance Intelligence Unlocking and Using Practice Performance Intelligence Patti Peets, Director, Revenue Cycle Management CareCloud, Miami Patti Peets does not have a financial conflict to report at this time. 1 Learning

More information

5 STEPS. to Prevent and Manage Denials. kareo.com

5 STEPS. to Prevent and Manage Denials. kareo.com 5 STEPS to Prevent and Manage Denials kareo.com Table of Contents STEP 1 Calculate Your Denial Rate 04 STEP 2 Identify Top Denial Reasons 05 STEP 3 Implement Eligibility Verification 06 STEP 4 Improve

More information

Improve your bottom line by reducing claim denials. Presented by: Mark R. Anderson, FHIMSS, CPHIMS CEO of AC Group, Inc.

Improve your bottom line by reducing claim denials. Presented by: Mark R. Anderson, FHIMSS, CPHIMS CEO of AC Group, Inc. Improve your bottom line by reducing claim denials Presented by: Mark R. Anderson, FHIMSS, CPHIMS CEO of AC Group, Inc. Today s agenda Mark Anderson webinar presentation Polling and Q&A session Sponsor

More information

Facility editing: Enhance payment integrity while building strong provider relationships

Facility editing: Enhance payment integrity while building strong provider relationships Facility editing: Enhance payment integrity while building strong provider relationships Optum www.optuminsight.com Page 1 Five steps toward effective facility editing It is a real challenge to edit facility

More information

CPT is a registered trademark of the American Medical Association.

CPT is a registered trademark of the American Medical Association. Welcome to s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year,

More information

How to Choose Your DME billing Company

How to Choose Your DME billing Company How to Choose Your DME billing Company The DME Specialists 2 With an aging population and three million baby boomers becoming eligible for Medicare coverage over the next ten years, the demand for durable

More information

Developing Billing Excellence. Presenter: Andrea Dickhaut, RDH, BSDH, MHA, Practice Administrator, DentaQuest Oral Health Center

Developing Billing Excellence. Presenter: Andrea Dickhaut, RDH, BSDH, MHA, Practice Administrator, DentaQuest Oral Health Center Developing Billing Excellence Presenter: Andrea Dickhaut, RDH, BSDH, MHA, Practice Administrator, DentaQuest Oral Health Center DentaQuest Oral Health Center Multi-specialty group practice NOT a safety

More information

FIVE WAYS TO HANDLE HIGH-DEDUCTIBLE PATIENTS IN YOUR MEDICAL PRACTICE

FIVE WAYS TO HANDLE HIGH-DEDUCTIBLE PATIENTS IN YOUR MEDICAL PRACTICE Billing & Reimbursement Revenue Cycle Management FIVE WAYS TO HANDLE HIGH-DEDUCTIBLE PATIENTS IN YOUR MEDICAL PRACTICE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals

More information

CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM

CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM The California Department of Managed Health Care has set forth regulations establishing certain claim settlement practices and a process for resolving

More information

LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES

LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES home health LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES Lynn Labarta, CEO, Imark Billing 1 home health LYNN LABARTA CEO, Imark Billing Founder of Imark Billing with over 15 years experience

More information

Moda Health Reimbursement Policy Overview

Moda Health Reimbursement Policy Overview Manual: Policy Title: Reimbursement Policy Moda Health Reimbursement Policy Overview Section: Administrative Subsection: None Date of Origin: 7/6/2011 Policy Number: RPM001 Last Updated: 1/9/2017 Last

More information

Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions

Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue

More information

Effective Billing and Collections. Copyright 2017 State Volunteer Mutual Insurance Company

Effective Billing and Collections. Copyright 2017 State Volunteer Mutual Insurance Company Effective Billing and Collections 1 Copyright 2017 State Volunteer Mutual Insurance Company Changing Environment Shift in responsibility, payment models and adjustments High deductible health plans (HDHP)

More information

Claim Reconsideration Requests Reference Guide

Claim Reconsideration Requests Reference Guide Claim Reconsideration Requests Reference Guide This reference tool provides instruction regarding the submission of a Claim Reconsideration Request form and details the supporting information required

More information

HUMBOLDT INDEPENDENT PRACTICE ASSOCIATION CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTIONS MECHANISM

HUMBOLDT INDEPENDENT PRACTICE ASSOCIATION CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTIONS MECHANISM HUMBOLDT INDEPENDENT PRACTICE ASSOCIATION CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTIONS MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has set forth

More information

Ann Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC

Ann Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC Ann Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable

More information

METHOD TO THE MADNESS TODAY S PRESENTER LEARNING OUTCOMES HTH FL Boot Camp. 10 payment collection strategies that work

METHOD TO THE MADNESS TODAY S PRESENTER LEARNING OUTCOMES HTH FL Boot Camp. 10 payment collection strategies that work METHOD TO THE MADNESS METHOD TO THE MADNESS 10 payment collection strategies that work 10 payment collection strategies that work Visit availity.com to download the full e-book TODAY S PRESENTER Colleen

More information

I. Claim submission instructions

I. Claim submission instructions Humboldt Del Norte Independent Practice Association And Humboldt Del Norte Foundation for Medical Care Claims Settlement Practices and Dispute Resolutions Mechanism As required by Assembly Bill 1455, the

More information

Fidelis Care uses TriZetto's Claims Editing Software to automatically review and edit health care claims submitted by physicians and facilities.

Fidelis Care uses TriZetto's Claims Editing Software to automatically review and edit health care claims submitted by physicians and facilities. BILLING AND CLAIMS Instructions for Submitting Claims The physician s office should prepare and electronically submit a CMS 1500 claim form. Hospitals should prepare and electronically submit a UB04 claim

More information

SEQUELMED Glossary. Advance Payment: An amount of money paid by a patient that cannot be applied against a charge at the time the payment was made.

SEQUELMED Glossary. Advance Payment: An amount of money paid by a patient that cannot be applied against a charge at the time the payment was made. SEQUELMED Glossary Account Number: SequelMed will automatically assign the next unique account number when the user hits the Save button. However, a user can manually assign an account # at the time of

More information

ACCOUNTS RECEIVABLE FOLLOW-UP CRITERIA

ACCOUNTS RECEIVABLE FOLLOW-UP CRITERIA Patient Balances Argus Billing Office follows the following criteria when dealing with patients balances. Argus Business Office will send five (5) statements; one (1) collection letter and will make one

More information

Cedars-Sinai Medical Group Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM

Cedars-Sinai Medical Group Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM Cedars-Sinai Medical Group Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has

More information

Kaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region

Kaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region Kaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region Kaiser Permanente ( KP ) values its relationship with the contracted community

More information

Section: Administrative Subsection: None Date of Origin: 1/22/2004 Policy Number: RPM002 Last Updated: 1/6/2017 Last Reviewed: 1/18/2017

Section: Administrative Subsection: None Date of Origin: 1/22/2004 Policy Number: RPM002 Last Updated: 1/6/2017 Last Reviewed: 1/18/2017 Manual: Policy Title: Reimbursement Policy Clinical Editing Section: Administrative Subsection: None Date of Origin: 1/22/2004 Policy Number: RPM002 Last Updated: 1/6/2017 Last Reviewed: 1/18/2017 IMPORTANT

More information

interchange Provider Important Message

interchange Provider Important Message Hospital Monthly Important Message Updated as of 11/09/2016 *all red text is new for 11/09/2016 Hospital Modernization - Ambulatory Payment Classification (APC) Hospitals can refer to the Hospital Modernization

More information

EFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK

EFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK EFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK 1 INTRODUCTION Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records,

More information

CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM

CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has set forth

More information

Billing for Rehabilitation Services

Billing for Rehabilitation Services Billing for Rehabilitation Services Julia R. Olson, CPC Austin-Webster Group, Ltd julolson@gmail.com (651) 430-1850 Disclaimer The information contained in this booklet is designed to provide accurate

More information

The Front-End Revenue Cycle Specialists. The Dilution of the Dollar

The Front-End Revenue Cycle Specialists. The Dilution of the Dollar The Front-End Revenue Cycle Specialists The Dilution of the Dollar The Silent Revenue Cycle Killer You are likely losing up to 40 cents on every dollar before you even render any patient services. By the

More information

CMS Provider Payment Dispute Resolution Mechanism

CMS Provider Payment Dispute Resolution Mechanism CMS Provider Payment Dispute Resolution Mechanism The Centers for Medicare and Medicaid Services (CMS) established an independent provider payment dispute resolution process for disputes between non-contracted

More information

CHAPTER 6 REVENUE CYCLE MANAGEMENT

CHAPTER 6 REVENUE CYCLE MANAGEMENT LEARNING OBJECTIVES In this PowerPoint presentation, we will learn about: Revenue Cycle Management in Healthcare Stages in Revenue Cycle Management Healthcare Revenue Cycle Process Revenue Cycle Management

More information

Chapter 7 General Billing Rules

Chapter 7 General Billing Rules 7 General Billing Rules Reviewed/Revised: 10/10/2017, 07/13/2017, 02/01/2017, 02/15/2016, 09/16/2015, 09/18/2014 General Information This chapter contains general information related to Health Choice Arizona

More information

INDIVIDUAL PRACTICE ASSOCIATION MEDICAL GROUP OF SANTA CLARA COUNTY (SCCIPA)

INDIVIDUAL PRACTICE ASSOCIATION MEDICAL GROUP OF SANTA CLARA COUNTY (SCCIPA) INDIVIDUAL PRACTICE ASSOCIATION MEDICAL GROUP OF SANTA CLARA COUNTY (SCCIPA) AB 1455 Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455,

More information

Complete Claims Processing

Complete Claims Processing Complete Claims Processing 1. All Complete Claims can be processed as soon as it is received. 2. Complete claims are identified properly by the claims processor when received from the mailroom, already

More information

Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions

Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue

More information

PUBLISHED BY: CareCloud Corporation 5200 Blue Lagoon Drive, Suite 900 Miami, FL Phone: (877)

PUBLISHED BY: CareCloud Corporation 5200 Blue Lagoon Drive, Suite 900 Miami, FL Phone: (877) PUBLISHED BY: CareCloud Corporation 5200 Blue Lagoon Drive, Suite 900 Miami, FL 33126 Phone: (877) 342-7519 Email: hello@carecloud.com Copyright 2015 CareCloud Corporation. All rights reserved. No part

More information

Healthcare Financial Management Association Certification Program. Module I: The Business of Health Care Learner s Guide

Healthcare Financial Management Association Certification Program. Module I: The Business of Health Care Learner s Guide Healthcare Financial Management Association Certification Program Module I: The Business of Health Care Learner s Guide For examination period beginning June 2015 1 Course 1 - The Big Picture Learning

More information

One or More Sessions Policy

One or More Sessions Policy One or More Sessions Policy Policy Number 2017R0118B Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

Management: A Guide To Optimizing. Market

Management: A Guide To Optimizing. Market Best Practices In Revenue Cycle Management: A Guide To Optimizing Your Revenue Cycle In A Value-Based Market T h e 2 0 1 8 O P E N M I N D S M a n a g e m e n t B e s t P r a c t i c e s I n s t i t u

More information

The Patriot Group. 11 Tips to Receive Payment for Medical Claims Fairly & Quickly. Level The Playing Field With These Best Practices

The Patriot Group. 11 Tips to Receive Payment for Medical Claims Fairly & Quickly. Level The Playing Field With These Best Practices The Patriot Group 11 Tips to Receive Payment for Medical Claims Fairly & Quickly Level The Playing Field With These Best Practices Table of Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

More information

Facility Billing Policy

Facility Billing Policy Policy Number 2018F7007A Annual Approval Date Facility Billing Policy 3/8/2018 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

CLAIMS Section 6. Provider Service Center. Timely Claim Submission. Clean Claim. Prompt Payment

CLAIMS Section 6. Provider Service Center. Timely Claim Submission. Clean Claim. Prompt Payment Provider Service Center Harmony has a dedicated Provider Service Center (PSC) in place with established toll-free numbers. The PSC is composed of regionally aligned teams and dedicated staff designed to

More information

Billing and Payment. To register, call UHC-FAST ( ) or your local Evercare provider representative.

Billing and Payment. To register, call UHC-FAST ( ) or your local Evercare provider representative. Billing and Payment Billing and Claims On the Web www.unitedhealthcareonline.com Register for UnitedHealthcare Online SM, our free Web site for network physicians and health care professionals. At UnitedHealthcare

More information

Pathology Practices: Are Your Payers Paying You Correctly? Are You Sure? Can You Prove It?

Pathology Practices: Are Your Payers Paying You Correctly? Are You Sure? Can You Prove It? Page 1 of 6 Pathology Practices: Are Your Payers Paying You Correctly? Are You Sure? Can You Prove It? Unfortunately in today s pathology practices, many of our contracted insurance companies pay significantly

More information

Section 6 - Claims Procedures

Section 6 - Claims Procedures Section 6 - Claims Procedures Claim Submission Procedures 1 Filing Electronic Claims 1 Filing Paper Claims 1 Claims for Referred Services 3 Claims for Authorized Services 3 Claims Resubmission Policy 3

More information

10/10/2012. Goals. The Exciting Future of Practice Management. Practice Management. Practice Management. The Future. Practice Management

10/10/2012. Goals. The Exciting Future of Practice Management. Practice Management. Practice Management. The Future. Practice Management Goals The Exciting Future of Practice Management Define practice management Current expectations of practice managers How practice management is changing Finding success as a practice manager Looking to

More information

Co-Surgeon / Team Surgeon Policy

Co-Surgeon / Team Surgeon Policy Co-Surgeon / Team Surgeon Policy Policy Number 2018R0052C Annual Approval Date 7/11/2018 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

10/10/2017. Course Objectives. Fundamentals of Accounts Receivable. Insurance 102: Accounts Receivable Management

10/10/2017. Course Objectives. Fundamentals of Accounts Receivable. Insurance 102: Accounts Receivable Management Insurance 102: Accounts Receivable Management Robin Elliott Operations Analyst Stacy Schiltz Operations Analyst Course Objectives Understanding the Fundamentals of Accounts Receivables Utilizing an Insurance

More information

Billing Guidelines Manual for Contracted Professional HMO Claims Submission

Billing Guidelines Manual for Contracted Professional HMO Claims Submission Billing Guidelines Manual for Contracted Professional HMO Claims Submission The Centers for Medicare and Medicaid Services (CMS) 1500 claim form is the acceptable standard for paper billing of professional

More information

Section 7 Billing Guidelines

Section 7 Billing Guidelines Section 7 Billing Guidelines Billing, Reimbursement, and Claims Submission 7-1 Submitting a Claim 7-1 Corrected Claims 7-2 Claim Adjustments/Requests for Review 7-2 Behavioral Health Services Claims 7-3

More information

Welcome! Ain t Just a River in Egypt! Identifying the Root Cause of Denials and Lost Revenue in Physician Practices.

Welcome! Ain t Just a River in Egypt! Identifying the Root Cause of Denials and Lost Revenue in Physician Practices. De-Nile Ain t Just a River in Egypt! Identifying the Root Cause of Denials and Lost Revenue in Physician Practices. Susan Welsh, MHA, CPC, CPC-I, PCS, CHC Welcome! 1 Objectives Identify the most common

More information

Auditing RACphobia. Lamon Willis, CPCO, CPC-I, CPC-H, CPC AHIMA-Approved ICD-10-CM/PCS Trainer Xerox Healthcare Consultant

Auditing RACphobia. Lamon Willis, CPCO, CPC-I, CPC-H, CPC AHIMA-Approved ICD-10-CM/PCS Trainer Xerox Healthcare Consultant Auditing RACphobia Lamon Willis, CPCO, CPC-I, CPC-H, CPC AHIMA-Approved ICD-10-CM/PCS Trainer Xerox Healthcare Consultant 1 Agenda Overview of present industry landscape in relation to auditing Audit Entities

More information

HIPAA 5010 Webinar Questions and Answer Session

HIPAA 5010 Webinar Questions and Answer Session HIPAA 5010 Webinar Questions and Answer Session Q: After Jan 2012, do the providers who bill on paper have to worry about 5010? Q: What if a provider submits all claims via paper? Do the new 5010 guidelines

More information

2017 Certification Course / CMBP Designation

2017 Certification Course / CMBP Designation 2017 Certification Course / CMBP Designation 1. INTRODUCTION TO MEDICAL BILLING Introduction to Medical Billing About Medical Billing Certification Requirements for a Medical Biller Medical Billing vs

More information

Common Reasons for Claim Denials and Ways to Avoid Them

Common Reasons for Claim Denials and Ways to Avoid Them Common Reasons for Claim Denials and Ways to Avoid Them The lifeblood of any thriving medical practice is a steady cash flow. It is, therefore, of upmost importance to recognize trends in payer denials

More information

Please submit claims and encounters electronically via Office Ally at

Please submit claims and encounters electronically via Office Ally at Claim Submission All claims must be submitted within 90 calendar days from the date of service for contracted providers unless otherwise stated in the provider service agreement. Please submit claims and

More information

How Hospital Finance and Reimbursement Works in Five Steps

How Hospital Finance and Reimbursement Works in Five Steps How Hospital Finance and Reimbursement Works in Five Steps Providing education, resources, leadership development to inspire excellence in health care governance. Like any industry, health care has its

More information

5 Steps to Reducing Administrative Costs in Physician Group Practices (A05)

5 Steps to Reducing Administrative Costs in Physician Group Practices (A05) 5 Steps to Reducing Administrative Costs in Physician Group Practices (A05) Presenters: Kenneth Willman, Director Provider Interface, Humana Melissa Lukowski, Director Outreach, athenahealth Mary Kelley,

More information

Payment Policy: Clinical Validation of Modifer 25 Reference Number: CC.PP.013 Product Types: ALL

Payment Policy: Clinical Validation of Modifer 25 Reference Number: CC.PP.013 Product Types: ALL Payment Policy: Clinical Validation of Modifer 25 Reference Number: CC.PP.013 Product Types: ALL Effective Date: 01/01/2013 Last Review Date: 02/24/2018 Coding Implications Revision Log See Important Reminder

More information

For Participating Rehabilitation Therapists May 2006

For Participating Rehabilitation Therapists May 2006 For Participating Rehabilitation Therapists May 2006 Updating coding resources A recent event illustrates the need to keep coding references updated. The 2006 ICD-9-CM code book published by a particular

More information

Commonwealth Healthcare Corporation Patient Revenue Cycle Management

Commonwealth Healthcare Corporation Patient Revenue Cycle Management Office of the Public Auditor Commonwealth Healthcare Corporation Patient Revenue Cycle Management OPA Report No. AR-17-01 Table of Contents Results in Brief... 2 Introduction... 3 Objective... 3 Background...

More information

Cenpatico South Carolina Frequently Asked Questions (FAQ)

Cenpatico South Carolina Frequently Asked Questions (FAQ) Cenpatico South Carolina Frequently Asked Questions (FAQ) GENERAL Who is Cenpatico? Cenpatico, a division of Centene Corporation, is one of the nation s most experienced behavioral health companies providing

More information

REINSTATEMENT And IMPLEMENTATION Of LAHIPP THIRD PARTY LIABILITY (TPL) CLAIMS PAYMENT

REINSTATEMENT And IMPLEMENTATION Of LAHIPP THIRD PARTY LIABILITY (TPL) CLAIMS PAYMENT REINSTATEMENT And IMPLEMENTATION Of LAHIPP THIRD PARTY LIABILITY (TPL) CLAIMS PAYMENT April 7, 2017 LOUISIANA MEDICAID PROGRAM DEPARTMENT OF HEALTH BUREAU OF HEALTH SERVICES FINANCING TABLE OF CONTENTS

More information

3 TIPS TO STOP REVENUE LEAKS IN YOUR PRIVATE PRACTICE

3 TIPS TO STOP REVENUE LEAKS IN YOUR PRIVATE PRACTICE 3 TIPS TO STOP REVENUE LEAKS IN YOUR PRIVATE PRACTICE You re not just running a private practice, you re running a business. But running a private practice today is more than providing quality patient

More information

Chapter 7. Billing and Claims Processing

Chapter 7. Billing and Claims Processing Chapter 7. Billing and Claims Processing 7.1 Electronic Claims Submission 3 7.1.1 How it Works... 3 7.1.2 Advantages... 3 7.1.3 How to Initiate... 4 7.1.4 Transactions Available... 5 7.1.5 NAIC Codes...

More information

Registration FSC/Plans & Invoice FSC

Registration FSC/Plans & Invoice FSC Registration FSC/Plans & Invoice FSC Overview Introduction This lesson introduces you to key terms and structure related to FSC/Plan Assignment. You will learn why an invoice FSC may be different from

More information

Section 8 Billing Guidelines

Section 8 Billing Guidelines Section 8 Billing Guidelines Billing, Reimbursement, and Claims Submission 8-1 Submitting a Claim 8-1 Corrected Claims 8-2 Claim Adjustments/Requests for Review 8-2 Behavioral Health Services Claims 8-3

More information

9/17/2018. Non-covered services. Description: Billing for services not covered under the Medicare program

9/17/2018. Non-covered services. Description: Billing for services not covered under the Medicare program Top billing and coding errors: Duplicate claims submitted The claim was previously processed (no payment made, allowed amount applied to deductible on the initial claim). The provider re-files the claim

More information

PROVIDER MANUAL. Revised January Page 1

PROVIDER MANUAL. Revised January Page 1 PROVIDER MANUAL Revised January 2018 Page 1 Table of Contents Introduction 3 General Information 4 Who Do I Call? 5 ID Card Logos 6 Credentialing/Recredentialing 7 Provider Changes 8 Referral and Authorization

More information

Claims and Billing Manual

Claims and Billing Manual 2019 Claims and Billing Manual ProviDRs Care 1/2019 1 Contents Introduction... 3 How to Use This Manual... 3 About WPPA, Inc. dba ProviDRs Care... 3 How to Contact ProviDRs Care... 3 ProviDRs Care Network

More information

Over 25 years of experience in the medical field, including 10 years of medical billing using Centricity. Eleven years with Visualutions, assisting

Over 25 years of experience in the medical field, including 10 years of medical billing using Centricity. Eleven years with Visualutions, assisting 1. Agenda 2. Credentialing 3. Clearinghouse 4. Company 1. Information 2. Identification 5. Administration Tables 1. Zip Codes 2. Fee Schedules 6. Responsible Provider 1. Information 2. Identification 3.

More information

Retrospective Denials Management

Retrospective Denials Management Retrospective Denials Management Weaving together the Clinical, Technical, and Legal Components Glen Reiner, RN, MBA, Western Region President Goals for our time together today Present an overview of effective

More information

Age to Diagnosis Code & Procedure Code Policy

Age to Diagnosis Code & Procedure Code Policy Age to Diagnosis Code & Procedure Code Policy Policy Number 2017R0086C Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee You are responsible for submission of accurate

More information

6 Degrees Health Reference Based Pricing Processes and Standard Procedures

6 Degrees Health Reference Based Pricing Processes and Standard Procedures 6 Degrees Health Reference Based Pricing Processes and Standard Procedures 6 Degrees Health Background 6 Degrees Health was founded in May of 2012, with a focus on providing transparent solutions backed

More information

20. CLAIMS PROCESSING. A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY:

20. CLAIMS PROCESSING. A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY: A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Providers. POLICY: A. All Capitated Providers are delegated the responsibility of claims processing for non- Capitated services and are

More information

Arkansas Blue Cross and Blue Shield

Arkansas Blue Cross and Blue Shield Arkansas Blue Cross and Blue Shield November 2005 Inside the November 2005 Issue: Name of Article Page Air and/or Ground Ambulance Claims Filing Procedures 6 Attachments to Claims 8 Bill Types for Facility

More information

Optimizing Revenue Cycle

Optimizing Revenue Cycle Optimizing Revenue Cycle CureMD User Conference 2014 Presented by Kelly J. Langschultz CEO & Founder of Precision Billing & Consulting Services, LLC www.precisionbillinginc.com Optimizing Revenue Cycle

More information

Rev 7/20/2015. ClaimsConnect Rejection Guide

Rev 7/20/2015. ClaimsConnect Rejection Guide ClaimsConnect Rejection Guide Helper Client, The purpose of this document is to assist you in accelerating the resolution of claim rejections. We have identified the most frequent rejection messages, and

More information

Gain a Revenue Cycle Advantage with More Effective Contract Management. Brendan Kreter Solutions Engineer

Gain a Revenue Cycle Advantage with More Effective Contract Management. Brendan Kreter Solutions Engineer Gain a Revenue Cycle Advantage with More Effective Contract Management Brendan Kreter Solutions Engineer Agenda Pressures in the Industry Snap Shot of Reimbursement Payment Compliance Claims Contract Profitability

More information

4 Ways to Drill Down into Bad Debt

4 Ways to Drill Down into Bad Debt 4 Ways to Drill Down into Bad Debt By Craig Kappel and Brett McMillan Conducting this four-step analysis of your hospital s bad debt is the first step to controlling it. Revenue cycle scorecards typically

More information

CLARIFYING INSURANCE CLAIMS What is an Insurance Claim?

CLARIFYING INSURANCE CLAIMS What is an Insurance Claim? CLARIFYING INSURANCE CLAIMS What is an Insurance Claim? Often those in the scleroderma community find themselves frequenting health care providers and being left with mounds of invoices and bills. Medical

More information

20. CLAIMS PROCESSING. A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY:

20. CLAIMS PROCESSING. A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY: A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY: A. All Capitated Providers are delegated the responsibility of claims processing for noncapitated services

More information

Payment Policy: Code Editing Overview Reference Number: CC.PP.011 Product Types: ALL Effective Date: 01/01/2013 Last Review Date: 06/28/2018

Payment Policy: Code Editing Overview Reference Number: CC.PP.011 Product Types: ALL Effective Date: 01/01/2013 Last Review Date: 06/28/2018 Payment Policy: Code Editing Overview Reference Number: CC.PP.011 Product Types: ALL Effective Date: 01/01/2013 Last Review Date: 06/28/2018 Coding Implications Revision Log See Important Reminder at the

More information

Prior Authorization Denial Challenges for an Integrated Health System

Prior Authorization Denial Challenges for an Integrated Health System Prior Authorization Denial Challenges for an Integrated Health System Focus Paper Mathew Smith, MPH, FACMPE August 30, 2017 This paper is being submitted in partial fulfillment of the requirements of Fellowship

More information

FUNDAMENTALS OF BILLING AND CODING

FUNDAMENTALS OF BILLING AND CODING FUNDAMENTALS OF BILLING AND CODING A Basic Training Series for Billing & Coding Staff in the Medical Office ACCMA 2011 About This Manual Copyrighted 2011, The Sage Associates, Pismo Beach, California and

More information

Medicare Accounts Receivable Management Strategies. Your Speakers

Medicare Accounts Receivable Management Strategies. Your Speakers Medicare Accounts Receivable Management Strategies Leading Age Michigan 2014 Annual Leadership Institute Friday, August 15, 2014 8:30 am 9:30 am 1 Your Speakers Janet Potter, CPA, MAS Manager, Healthcare

More information

Indiana Health Coverage Program Behavioral Health Presented by CompCare October 22-24, 2007

Indiana Health Coverage Program Behavioral Health Presented by CompCare October 22-24, 2007 Indiana Health Coverage Program Behavioral Health Presented by CompCare October 22-24, 2007 Topic Behavioral Health About MDwise About CompCare CompCare Provider Contracting Process CompCare Quick Contact

More information

Welcome. The Best Care. Because We Care. -1-

Welcome. The Best Care. Because We Care. -1- Welcome Second Quarter 2007 EDS Workshop Presented by Corporate MDwise Sherri Miles Provider Relations Manager Jacquie Marsalis-Provider Relations Manger/CompCare The Best Care. Because We Care. -1- About

More information

Health Information Technology and Management

Health Information Technology and Management Health Information Technology and Management CHAPTER 9 Healthcare Coding and Reimbursement Pretest (True/False) CPT-4 codes are used to bill for disease and illness. Medicare Part B provides medical insurance

More information

Passport Advantage Provider Manual Section 13.0 Provider Billing Manual Table of Contents

Passport Advantage Provider Manual Section 13.0 Provider Billing Manual Table of Contents Passport Advantage Provider Manual Section 13.0 Provider Billing Manual Table of Contents 13.1 Claim Submissions 13.2 Provider/Claims Specific Guidelines 13.3 Understanding the Remittance Advice 13.4 Denial

More information

Practice Management Advanced Reporting. Presented By: Molly Endress

Practice Management Advanced Reporting. Presented By: Molly Endress Practice Management Advanced Reporting Presented By: Molly Endress Session Pin Don t forget to collect your pin as you the leave the session. Clinical Financial Value Based Care Success Patient Engagement

More information

Revenue Cycle Internal Audits

Revenue Cycle Internal Audits Front, middle and back office considerations New England Healthcare Internal Auditors November 30, 2016 Introduction Dave Dreher, Partner Americas Health Internal Audit Leader Andy Adams, Partner Dave

More information

Managed Care Readiness Training Series: Revenue Cycle Management 3 rd Learning Community Claim Submission and Payer follow-up

Managed Care Readiness Training Series: Revenue Cycle Management 3 rd Learning Community Claim Submission and Payer follow-up Managed Care Readiness Training Series: Revenue Cycle Management 3 rd Learning Community Claim Submission and Payer follow-up Claim Submission and Payer follow-up Presenter: David Wawrzynek MS, MBA Managed

More information

Documenting to Support. Medical Necessity. for the Pediatric Dental Professional

Documenting to Support. Medical Necessity. for the Pediatric Dental Professional Documenting to Support Medical Necessity for the Pediatric Dental Professional Documenting to Support Medical Necessity for the Pediatric Dental Professional What is Medically Necessary Care (MNC) and

More information

Practical Strategies to Improve Laboratory Financial Performance

Practical Strategies to Improve Laboratory Financial Performance Slide 2 SML1 Sunrise Medcial Labs, 04/09/2008 Practical Strategies to Improve Laboratory Financial Performance Executive War College 2008 Miami, Florida May 14 th, 2008 Martin Colucci, CFO Sunrise Medical

More information