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Lack of feedback from back to front office on coding issues perpetuates a cycle of denials. Here are five tips to help get claims paid the first time.
Poor documentation is a major cause of denied claims but many clinicians don't make the connection between an inaccurate chart note and stagnating revenues. That could be because they don't know what they're doing wrong or how to fix it, according to experts. Reversing the cycle of denials due to poor documentation requires a commitment to communication between front- and back-office staffs.
"It's important to demonstrate to clinicians how coding affects reimbursement and how documentation impacts how we are coding," said Ben Colton, senior manager specializing in revenue cycle optimization at ECG Management Consultants in Seattle, Wash. "As we transition to ICD-10 that higher level of documentation is critical."
Providing inadequate information on claim filings is among the top five reasons for denied claims, according to a recent analysis of spring 2015 claims data by RemitDATA for Physicians Practice. Still, providers often get little or no guidance on how to improve their documentation, said Lucy Zielinski, vice president of The Camden Group, a Los Angeles-based healthcare business advisory firm.
"My approach as a certified coder is to look at an audit of the charts and provide one-on-one feedback to providers," she said. "Often providers tell me that they do not get any feedback on denials from their billing department, but they would love to know what they're doing wrong."
Education, training, and communication are key to improving documentation on the front end of the revenue cycle, experts say. Here are five tips on putting those processes in place to increase your chances of getting claims paid the first time.
• Open the lines of communication. Coding and billing staff should deliver regular feedback to clinicians about the reasons for denials, said Zielinski. Since that doesn't always happen on an informal basis, it's a good idea to establish a regular forum for discussing billing and coding issues, such as monthly meetings or online user groups.
• Perform a baseline audit. Before developing a training strategy for providers, conduct a baseline assessment of their coding skills, said Zielinski. "If they are coding appropriately, repeat the audit once or twice a year - if not, you may need to do it more frequently."
• Target training to clinicians. Newly hired providers should attend an educational seminar on the basic fundamentals of the revenue cycle, said Colton. Going forward, clinicians should attend classroom training sessions once or twice a year to keep them abreast of any changes in documentation requirements. Providers should also receive specific, regular feedback on the primary reasons for denials, he added. "They should know what they could be doing more effectively to capture all necessary charges to support optimal billing."
• Connect compliance to compensation. Some practices tie part of clinicians' compensation or bonuses to compliance with coding audits or attendance at educational seminars, said Zielinski.
• Leverage your technology. Catching and fixing errors is important but a complete audit may be overkill in a small to mid-sized practice, said Colton. Instead, take advantage of "scrubber" tools embedded in your EHR or practice management system that search for coding errors and generate reports on recurrent problems. "Look at those reports on a monthly or annual basis and have a coder work the fallout," he said.