Pulmonology Coding Alert

Question: We received provider remittance advice from an insurance company. What can we do with this?

Mississippi Subscriber

Answer: Medical practices can utilize their RAs to streamline their processes. Tracking RAs will help you identify rates of claims denials, and categorize reasons for them. With that information, you can improve your practice’s claims accuracy and maximize legitimate payment for services.

All billing staff should spend time studying the reasons cited for adjustments or denials from the RA they received. Track RA messages to find any patterns of inappropriate adjustments, such as incorrect modifier use, bundling problems, secondary procedure reduction, among others. Also look for denial reasons, such as, code not covered, not medically necessary, demographics incorrect, etc.

Track pay: Billers should also use RAs to compare payment received to the published fee schedule from the insurer.

Focus on denials: Using denial information from RAs, you can analyze trends that are costing you money. Compile your data into a denial trend report that lists reason codes, remark codes, and group codes. Sort your report by reason code so that you can quickly spot denial trends.

Once you’ve uncovered denial trends and root cause, you can take steps to reverse them. This may involve educating staff, educating clinicians, beefing up your ABN procedures, redesigning workflows, reviewing NCDs and LCDs, or refining your ICD-10 coding to better express medical necessity.