Reimbursements
Denials and underpayments are defects in the revenue cycle that indicate a provider’s inability to comply with payer requirements or a payer’s inability to accurately pay a claim. CRN Healthcare Solutions works with practices to evaluate and implement lean process workflow denials management so that every dollar not paid which should have been paid is addressed and followed up. We work with the organization to provide process and workflow improvement to identify and appeal these underpaid and denied claims. We have implemented a web native tool that is independent of the organization’s practice management system and claims clearinghouse. This tool automatically analyzes ERAs and applies rules to place suspect payments and denials in the appropriate work queues. It adapts to comply with your payer contracts and timelines. The Denial Management Solution utilizes dashboards and key performance indicators to provide quantitative management where data is measured and used to drive improvement decisions.
The Denial Management Solution utilizes dashboards and Key Performance Indicators – including HFMA MAP Keys – to provide quantitative management where data is measured and used to drive improvement decisions. Trending analysis feeds continuous improvement efforts. In addition to the dashboards, reports can be printed as searchable PDFs or output in Microsoft Excel format to provide full visibility of this critical segment of the revenue cycle. Our tool links directly to a Wiki that provides a repository of knowledge that will assist your denial management team in taking control of the appeals process. The Wiki can be available across all involved departments to assure organizational accountability.
The CRN Healthcare denials and appeals management tools help increase productivity by standardizing processes and providing explicit instructions for each step in reviewing, fixing and/or appealing a denial. Data is automatically extracting from ERAs into case records. The data in the case records can auto populate fields in complex payer forms that are converted into fillable PDFs. The same data can be merged into appeal letter templates using Microsoft Word. This results in significant time savings and reduction of transcription
Call us at 732-389-3110 or 732-233-7660 (cell) to discuss your reimbursement needs, set up a demonstration via a web meeting and how we can help you with your specific denials and appeals management challenges
When Non-Covered and Covered Procedures Are Performed
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Understand Clearing Houses
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Modifiers 52 and 53 vs. 73 and 74
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E/M Documentation by Med Students Rules Clarified
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Audiology Technician Billing
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Coding 3 or 4 Sinuses Using FESS Codes
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Denials Management for the Medical Coder
Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit pro… For more,...
Blue Cross of Mich. Reverses Decision
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OIG: Many Outpatient PT Claims Fail to Comply
The Office of Inspector General (OIG) did a study of physical therapy claims and documentation for Medicare patients and issued a report this month in March. Their findings are of great concern for the PT and rehabilitation specialty. The OIG reviewed… For more,...
Post-Operative Complications in the Global Period
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