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Revenue Cycle Management: Preventing Claim Denials

Preventing denials requires careful documentation but physicians don’t always make the connection between poor documentation and declining revenue. As a result, some offices get stuck in a downward spiral that’s difficult to reverse without a coordinated effort between the front and back office.

Revenue cycle management experts I spoke with had some great tips for reversing that negative trend. Here are 5 worth noting:

Communicate. Physicians, nurse practitioners, and physician assistants should receive frequent, direct feedback about the quality of their documentation. Whether your billing staff is medical revenue cycleon-site or you work with a third-party, you need to know how often and why your claims are denied. Consider having regular staff meetings or online discussions focused on billing and coding.

Test for coding competency. Perform a baseline assessment of providers’ coding skills and repeat it twice a year to make sure everyone is up to speed.

Invest in training. Both newly hired and established providers should undergo regular training and refresher courses on coding and documentation. Remember: poor documentation + inaccurate coding = denied claim (and lost revenue).

Show them the money. Complying with coding audits and attending educational seminars should be tied to financial compensation and/or bonuses.

Use technology. “Scrubber” tools embedded in your practice management system search for coding errors and generate reports on recurrent problems–consult them regularly to avoid repeating common errors.


Please see the longer version of this column that I wrote for Physicians Practice.







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