Practice Management Alert

3 expert tips help you eliminate the root causes of your rejections

Denial management is a mammoth task, but billing education and carrier networking can help you take down the beast.
 
Last month we advised you on how to create a "Top 10" denials list to streamline your denial management (see "Spear- head your Denial Management Efforts With a 'Top 10' Rejections List" in the December 2004 issue). But once you've compiled your most-common denials list and identified the underlying causes, it's time to take action.

Try these three denial-busting tips:
 
1. Assign denials to your billers based on carrier. Think of this as the "divide and conquer" approach, which allows each of your billers or billing teams to specialize in dealing with certain carriers.
 
"I have one team that strictly works Medicare, one that works commercial, then one that only works HMOs," says Mike Edmonds, owner and executive director of Physicians Financial & Management Services LLC in Cordova, Tenn. This system allows billers to develop a close relationship with the claims rep at each carrier, so the reps will be more helpful than if a different biller calls each time, Edmonds says.
 
2. Maintain a carrier contact database. Whether you choose a Rolodex, paper file or computer spreadsheet, the important thing is to know your claim rep for each payer so you have a personal contact to go to with questions, Edmonds says. "Networking is a key to making denial management work."
 
3. Arrange regular billing meetings for both physicians and billing staff to attend. Sharing your current "Top 10" denials list can help guide a discussion on ways to improve, says Terri Fischer, CPC, CMC, manager with LarsonAllen Health Care Group in St. Louis, Mo.
 
"I meet with my doctors at least every quarter and we talk about the top reasons for denials," Edmonds says. "Denial management is a team effort," and it only works if everyone is on board together and on the same page, he adds.
 
Personal attention: If a particular physician or biller is causing a denial problem, direct one-on-one education regarding the denial is the best way to nip the problem in the bud.