In today’s reimbursement world, average denial rates among providers are greater than 10% with best practice being at or below 5%. So how do you effectively analyze and assign workflow to prevent timely filing for possible rebills or appeals; with some timely filings being as low as 60 days? TECHNOLOGY
At Medco we utilize our proprietary Payor Compliance™ software suite. Payor Compliance utilizes contract management solutions and denial workflow based on granular denial code analysis to effectively identify trends causing revenue leakage. Thus, MAXIMIZING clients’ reimbursements!
The Secret to Success?
Using CARC code CO16 as an example. CO-16 translates to “Claim/service lacks information or has submission/billing error(s)” Every payor will utilize this denial code along with many others differently. To further define these type CARC codes, some payors will assign a RARC code along with the CARC code. Such as, utilizing M76, which is defined as “Missing/incomplete/invalid diagnosis or condition” or MA112, which is defined as “Missing/incomplete/invalid group practice information.” Analyzing denials based on sub codes allows quick identification of the root cause of the denial and allows the denials to be worked much more efficiently. In some cases, multiple accounts can be corrected at the same time.
Why utilize a contract management solution to further analyze opportunities?
Continuing with the CO-16 above, utilization of contract management calculates the expected reimbursement for each claim. Stated above CO-16 is utilized differently among payors. A RARC code for M119 along with the CO-16. RARC code M119 is defined as “Missing/incomplete/invalid/deactivated /withdrawn NDC number.” However, the service being billed is not payable according to your contract with said payor. By knowing your expected reimbursement you can review if the claim was paid appropriately even with a denial given on the claim. This would eliminate the time for a collector to rebill or appeal a denial where you would not be expecting any further reimbursement.
Try it today!
Contact MedCo to discuss analysis of your AR and to take advantage of effectively resolving your AR and lost revenue!
Headquartered in Huntsville, AL, MedCo has over 25 years of experience providing world-class customer service and higher than standard performance in the healthcare revenue space. MedCo is a technology based RCM company with particular areas of expertise in Patient Access, Early Out, Bad Debt, AR improvement and Lost Revenue recovery. The company boasts many long term clients as proof of performance in the industry.
For more information visit www.medcoservices.com or call 1-844-528-4338