Streamline Your Billing Process with a Medical Invoice Format for Operations

Medical invoice format for Operations

[Music] [Music] he [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] w [Laughter] hello happy Friday Eve I messed something up at the beginning there sorry Nicole hey guys how's it going I hope you guys are having a peaceful week leading into this holiday can you believe that it's Thanksgiving next week like I cannot believe that we're already here in the holiday season it has snuck up on me again how does that happen how does that happen my my daughter who is now an adult those of you um who've hung out with me before know that um she's like of that same belief that when you're in adulthood all of a sudden time just flies by when you're like a teenager everything is endless it's like school year is never ending and summer time feels like an eternity in all the good ways so um but now it's like you snap your fingers and it's the end of a year or it's the end of a month those of us in medical billing I feel like that's the the norm so hello if you are new here here welcome my name is Jasmine I'm very very happy to have you here in this space this is in Lara University we are on our medical billers Network Live this is our Thursday home the place where we hang out on Thursdays I'm noticing that I probably messed up our overlay here there we go that's medical billers Network live so we are um here every Thursday this is 2m today we are starting off kicking off our discussion about denials so it is going to be like a little miniseries if you um oh goodness if you are brand new to denial management or working on denials denial resolution um this will be a great conversation for you to be a part of my folks who are experienced please weigh in because those of you who are in this world know that we all have our unique scenarios and your perspective is huge for everyone else on the other side of the world the country that might have your same situation your same scenario that I maybe do not have so I would I really would love to have you guys join in but before we do that when you get in this space say hello let me know that you're here like Osama did here hi Osama good to see you friend welcome back welcome back okay um and I'm gonna quickly prompt you on the question of the day that I'm looking at what's your most common denial it shows up on my screen so hello say hello in the comments and um you can let me know where you're dialing in from and answer the question of the day which is what is your most common denial what are you seeing a lot and um today we're going to talk a little bit about resolution so hey chrisy what's up good to see you really good to see you friend all right before we do that or while you guys are doing that typing your denials out there letting me know that you're in the house I'm going to quickly do our run through here so this week you're talking about resolving common denials last week we talked about denial um the number one denial which is data capture so um in healthcare so many things and I say data capture there's probably the top if you look in at a top 10 list at least five to six of those items are related to data capture and so we'll talk a little bit more about that over the series here together the week before that the trivia Party happen for November it we we talked a lot about health insurance which is the theme of this month because it is the course of the month we are going to be launching our us health insurance course because of a lot of requests from people you guys all want to know more about it and I think that it's so helpful for everyone to know a lot more about the models and the Styles and the products here that we have in the US because it's so different from other countries and um it really is vital for anybody in the health insurance or the healthcare world really to understand more about the different carriers all right so if you are brand new to our Channel don't forget to subscribe and if you like what you hear whatever we're talking about wherever you are on your screen you probably have a thumbs up or a heart or one of those things that tells that program that you like this content so if you don't mind bring that little bell that hello thing that tells them that you like it and then consider subscribing if you're watching us here on YouTube you might also notice that we now have memberships yay super excited to have rolled out our membership so you guys will start seeing our shout outs to members here shortly and my friends if you are brand new to memberships and don't know what the heck I'm talking about if you go to our homepage on YouTube you will see a button that says join and you can check out the current level there's only one level right now our second level will open or launch in January and um you can learn all about how to get connected to us and the details and the and the badge information all that stuff it's kind of cool it's kind of cool I just you know I think it's cool so um yeah if you guys want something in those memberships let us know I'm very curious oh thank you so much for popping the the link there in the chat let me know what you want to see in memberships because I'm curious we already have our ideas kind of slated out for the memberships T out but maybe there's a way we can insert fit in a space for things that you would like to see we love to make sure we get you guys um what you want in your membership if you want to be connected to us on socials all those links are there feel free to jump into those links if you are new to Ina we are a functioning fully functioning medical billing company revenue cycle management is our art form we also do Consulting related to that we then also have our education side so here on YouTube this is all free education we do this live stream once per week we have videos and shorts and other things that go up on the same channel majority of this information is at this time medical billing related and the entire channel is Health the business of healthcare related so we will also talk things like uh practice management and credentialing and front end of revenue cycle which is our receptionist some analytics and Healthcare administrative management so you'll you'll see like a good mix of content there on the channel and over the next few months weeks years we have a lot more in store and and so with that said talking about education also have an educational um what do we call this programs we have programs that we that we offer as well so these are more we'll say organized formats of the information that you might see a mixture of very light versions of what you see here on YouTube so a couple of examples we've got two different types of ways that you can work with us on the educational program side and that's with self-paced courses and instructor-led courses so on the screen is an example of our instructor Le course we are actively in a mastering medical building right now the next one opens up in J no February in February so but check it out because right now we are running deals on all programs so it's really really important that you pop on there now because right now we run we are running Black Friday deals until Monday Cyber Monday I believe so we're going to continue those on but essentially you could get this course get committed get get yourself in those courses even with the financing options with those deep discounts all right so other example of self-paced course or another example of our course is a self-paced course which is that intro to us health insurance which I just mentioned a little bit ago and so with that said let's talk get ready to solve denial this is Nicole this is this is really funny Nicole I like it not a good I love that that's hilarious okay thank you for that little giggle Nicole that's amazing okay so first of all my friends I want to just quick disclaimer that this is medical billing you are all going to find your own unique scenarios in all different corners of Specialties and states with carriers that are that will run the gamut of variety right you will have a mass variety of scenarios or situations that might be different than what I so as I mentioned earlier if you have experience in a particular specialty or see a certain type of denial please please let us know what you see christe celebrating your your image there yeah we we get a kick out of Nicole's humor sheth bomb.com I'm oh let me pop up real fast I missed some comments here okay so real quick we've got a couple of updates so Ashley says coob we'll talk about that a little bit today christe says eligibility oh yeah say hey Trudy good to see you you another North Carolinian in the house I love it so good afternoon iny worker hello it's been a little while it's good to see you friend welcome back welcome back all right so um so yes so know that what I talk about today and what we're going to be talking about today there might be unique scenarios that you might have a better perspective or a different perspective than what I say so please feel free this goes with anything that we talk about on this channel this is not about Jasmine it's not just highlighting Jaz and me yammering on I want to get everybody's input because we are a community here all right you guys know this if you've been here before that that is my motto my battlecry is we can only do this together we can only make these changes together so I want to quickly open up something on my screen so that I can remember where I'm supposed to go in our next chat here okay there we go all right so I talked about this already that we are going into kind of a minseries um this week and next week is Thanksgiving we will I will pop on next week to chat with you guys we won't talk denials but the following week we will continue this conversation about denials so if you over the next few days gather some more information or if you're looking at this video on the replay please feel free to make comments and we'll revisit it and we'll take a look at those comments and see if we can address some of your questions issues concerns so those of you who have hung out these last few weeks we've talked a lot about data capture frontend ception front end of the revenue cycle right this these types of um processes that we've discussed and essentially the the challenges that we're all facing these the area of discussion these last few weeks has really lend itself to this to really be useful in this conversation that we're having today because still data capture related denials takes the place for number one which means the way that you can help alleviate what you are experiencing with these denials is by improving upon your understanding of the front end and how well it should function and also preventing those denials right so the best and first line of defense is always prevention right is always prevention so we are looking to try to prevent these things from happening in the first place now some of us do not have control over that some of us do not have access to the front end to be able to make those changes so I completely know and understand where you might be struggling with making an impact on the front end all right so first thing I'm going to make a mention of for you guys who don't have control is find out whether or not there's someone in your department organization that can have an impact all right so if you are understanding the types of denials that you have an example like christe mentioned for eligibility is there a way that someone in your department could communicate with the powers that be on the front end to help integrate some useful tool that happens checks eligibility before the patients are even seen in the practice all right so that's one example of ways that we can leverage um our tools our resources to encourage the the practice to function better and hopefully result in preventing these denials in the first place so when we know what our denials are we can have a better path to resolve them so the next most important thing is to know become familiar with to wrap your head around the denials that you are seeing most often so we're going to talk a little bit more about denial Management in our next conversation because denal management is more um Gathering the data and trying to make use of the data so you can create a better strategy that's a little different um than resolution really and I say dell management really should come before resolution right we should get ourselves organized know exactly where to head so we can create a proper plan of action all right but today we're chatting briefly about denials and denial resolution we're going to touch on that and we're going to tap into res to management and then revisit more ingrained resolution CH conversations all right so if you are first time in a practice and you are trying to work on denials the thing that I would absolutely suggest that you do right away is make sure that your software is not just blanket blanket write blanket writing off yeah just writing off all of the denials without noticing what type of denials are okay to write off for example a co45 we know co45 as long as a client the practice is contracted with the carrier that is an anticipated denial we do not need to work work those denials okay we don't need to we don't need to do anything with those denials those denials are expected or anticipated and that would get written off just fine however other denials that we know need potentially some kind of recourse medical documentation related or what we just talked about things related to denial cap capure that are challenges with patients um setup um in their in their in the in your software on the claim forms right those are all things that we don't want our software doing any sort of automatic blanket writeoffs for those particular cosos all right and I say that because I see a lot of systems that have really both ends of the spectrum first really severe writing off of all things Co because it says contract OB obligation or contractual obligation the software has been told or set a rule has been set that says when you see the a CO it's a part of the contract you would need to write it off and that doesn't allow us as billers to be effective of what we do right to be able to fight for the claims to be reimbursed so it's important that you are clear about this being the severe type of Co not being the thing that we want utilized in the department and then on the other side of it you don't want it to be the rule to be either not implemented at all or too light because things like co45 we don't need a co45 we don't need other types of anticipated denials that are going to come in for example um The Prompt paid discount c44 where we know that we were accepting payments from companies like zealous or folks that are um that are reimbursing us and reducing our payments down slightly because we have elected to um to receive those payments faster that is that doesn't require us to do anything as billers to fight for additional compensation because we've agreed to that all right so it's super important to understand that our system setup is going to make or break how effective we can be and how um clean or denial process can be because so many hi Belinda good to see you good to you welcome back so many people um try to Dive Right into denials without first evaluating whether things are set up correctly and they realize they've got a mountain of denials and they're cleaning up things like Co 45s or things that we know are going to um be writeoffs that we don't need to acknowledge and it's a waste of time and resources for you to be thumbing through these denials and not needing to do anything with them okay all right so next thing um when it comes to denial management we're going to talk about this a little bit more you really want to understand what your top denials are for your practice and become very very familiar with those denials and what your path to resolution is and we'll talk more about how to organize yourself in that way in our next chat however in this in this discussion what I really want you to be thinking about is how can I become familiar with the denials that I see and what are the denial what are what are the steps that I am taking that are most that are resulting in the the the best uh results right so if we know that for example you have an insurance carrier situation where your authorizations are slow getting approved slower than your claims so you are sending claims out before before the insurance company has um updated their records with an authorization so you have claims denying for a lack of authorization and you have to go back through and request the insurance to reprocess those claims if you know that is a scenario that you see on a very regular basis you're going to number one you're going to figure out what to do for the ones that have already gone out the door and then you're going to create a a very clear path of how to resolve those for yourself and anybody else that might be supporting you or helping you and then you're going to try to prevent that from happening right so go to whomever whether it's you or an administrator in the practice um or in the in the billing company that can help you prevent claims from going out faster than the authorizations are getting approved and sometimes that's as simple as delaying claims for a particular um plan type or Insurance type all right meaning you won't send those claims as quickly as you might be sending all of your other claims so if you are on same day adjudication like I have seen practices that have same day submission if the encounter happens in the morning and the provider closes it the claims go out in the afternoon that's cool but if you just submitted an authorization that same morning for a patient's service you're probably not going to get the proper outcome for a claim if you just then if you just waited a couple of days and sent that same claim out the door okay all right so speaking very broadly um just to give you some good examples there of of what I mean when it comes to creating a path for your own resolution um because you guys are going to be the best resource for creating a denial resolution workflow for your self or your business if you're creating one for a business or a department all right because you your your situations are going to be unique but you can use these examples in what we're talking about today to help apply a better strategy all right so with that said um I want to quickly talk a little bit about zoom out just a little bit about these codes we we've touched on this in previous videos but I want to make sure my friends that are brand new or joining us for the first time in these types of discussions around denials I want to ensure that you all are clear on exactly what resources we recommend for looking into um denials and denial codes because there are software out there that will send you um kind of incomplete reasoning definitions for your reason codes or your denial the the the the codes that we're receiving for our claims and I'm going to walk you through I'm sorry while while I'm doing this I'm trying to dock in I'm not very good at that okay here we go all right so this is the site I I've mentioned in the past this is X12 they are the resource that you they they will be the ones that publish the record for the denial and remark codes so we've got two different types of um sorry I'm realizing trying to modify the wrong screen okay we've got two different types of um of codes here really so the Remar codes is something um else I want to zoom out here we go yeah and show you guys first our claim adjustment reason code groups all right so my friends who are brand new to the world of medical billing when we receive our remits which is our eobs or electronic remittance advice um remittances are the details about the payment right those are those are usually accompanying the deposit that you're receiving so you're getting it the same day as the deposit in some electronic form or it's accompanying a physical check all right on these documents whether they come electronically or on paper in the the mail and snail mail you will see codes at the bottom of them all right and we'll I'll show some other examples of those codes um of the of an EOB on a different date you could look some of our other videos that have EOB examples as well but oh I'm so sorry trying to expand this on my side okay however when we see these we've got really a few different types of groups so the primary codes that we see are what are called claim adjustment reason codes all right these these codes are going to be typically right against the line item of the denial meaning the reason the the line the the uh line that was not paid by the insurance carrier you will see a code next to that zero right and there's typically a column there that says something like claim adjustment reason code or for short it's going to say CC all right so these code Cades are they do come from a resource and they are public Resource One one of the reasons why the this ANC which is the standardization of our um of our electronic World being leveraged in healthcare this this is born from from ansy the ansy coding has done something for us that's great which is it creates a lot of standards in the way that we receive our denials or the reason for the denials okay now the truth is is that these codes the adjustment reason codes are sometimes not leveraged in the best way because these systems are really they're they're moving quickly and most of them are happening through rules that are set up at the insurance company Clearing House or in their adjudication systems okay which is their claims processing systems so when they see the claim and they decide it's not it's not proper for payment sometimes they use a very vague claim adjustment reason code okay and that is when we will want to Leverage What are called remittance advice remark codes both are are are um available on your remittance or your EOB so when we talk about denials we usually are thinking about these claim adjustment reason codes the things that are Co and PRS that we see most often or even the OAS however what you're also going to want to look at for clarity are your re remittance advice remark codes these are additional comment codes that provide more information about the primary claim adjustment reason code all right there are a lot of General codes that are out there my friends who have been in Billing for a long time know um what I'm referring to like the notorious Co co6 the claim lack claim lacks information um was it claim or service lacks information um needed for adjudication like those kinds of of um of denials that we receive they're just so vague and they could mean a lot of different things depending upon the the specialty and the state that you're in so it's important to understand that you are looking for both the claim adjustment reason codes and the remittance advice remark codes most people are not paying attention to the remittance advice remark codes and it gives us a lot more information and I say most people sometimes the software only captures if you are working from a denial queue sometimes your denial cue only captures the primary claim adjustment reason code and does not reflect the remittance advice REM Mark code and so you go out to make your phone call to do all this extra rig andaro and you had right on the ri the EOB if you pulled up the EOB or the remittance itself and took a look at the EOB you might have plenty of information here from your remittance advice remark code all right so if your system for whatever reason the remittance that you're looking at or the paper EOB does not have the detail of the the remark code you can come to these this software this um resource and search for it it has the entire list here the entire resource available it doesn't give you a pathway to resolve it by any means but the information or the definition is present okay so quickly talking about the groups here just to talk about a couple of really important ones to know the differences between Co typically means that there's some sort of contractual indicator that is preventing the claim from being Deni from being paid and causing it to deny or causing it to reduce for any variet of reasons including a co45 which is reducing it because you have a contract now a PR is the second most common um group code that we will see on the ER and the pr just very simply means that they are determining that this particular service instead of it being written off it's going to Patient responsibility now it doesn't mean that you should just drop it to patient and call it a day no it will put it to Patient responsibility if you don't have um let's say the right insurance information on file or if you don't have an authorization on excuse me a referral on file it's going to drop it to patient and if your patient did in fact bring that referral or you know that you received that referral you could very well go ahead and appeal for payment so it just because it has PR doesn't mean you should ignore it but it is important to know that there are some PR denials that you'll get for things like eligibility that um are ones that you can resolve okay so we're we're staying a little high level here at the very front end this chats I want to just make sure that I cover all of the um the stages that you guys might be in so sorry keep trying to move my screens around okay yeah so as we're here underneath our the details here you'll notice that it goes in in numerical order so you could type in the code that you're looking for if you don't have reference to it now there a lot of them ref reference these additional pieces here this is very simply stating that there's some antsy Loop basically electronic Loop that is telling you that it's present you don't have to pay any attention to this guy um after that typically that first main section here is the one that's going to be the most useful for you okay all right so when we're looking at this type of um system so if I go to like co6 for example and it says claim LAX information that's that's um I'm sorry claim or service information or has submission billing errors this could mean a lot of things so as I said you're going to want to then refer to your remittance advisor Mark codes because what this me could mean is that you have something wrong with the coding that's present on the claim it could mean that you um did not obtain an authorization or send a referral in there's there's all kinds of denials that we see with co16 because it's so vague right it could mean that there's an operative report that's needed to sometimes they use the wrong code that that communicates that an operative report wasn't present all right so what you're going to this is typically some of the things that we might see for operative reports down here as well um so what you're going to want to do is view is pop over to that remark the the um remittance codes sometimes it's not on the line and you're going to see it at the bottom of the EOB and you'll see some additional codes and how do you know if they are um remittance advice or Mark codes the way that you will know is these are all of our um claim adjustment codes they will always have these two digits ahead of them okay when it comes to remark codes they typically have a singular digit see that a singular digit so it's either an m and sometimes an Ma and sometimes an n as a Nancy okay so those are the most common ones and you see here it just has a lot more detail about specific information right missing incomplete ordering provider address right it's giving us more specific information about the reason for the denial itself okay so I want to just make sure that you guys are looking into both your remark codes and excuse me your reason codes and your remark codes because these comment codes can give you the exact Pathway to resolving it so we sometimes we think to water down and we're like oh we just see these um Co 272s which is services are not provided not being provided by Network or Primary Care Providers but perhaps it says something a lot more perhaps you have a little bit more detail about the special specialty or specialist not being in that that patients Network right so just thinking about that it's uh the the kind of General topic there and I'm going to try to close out of this if I I wish I had a better um workflow for closing out of this there we go all right okay so um so yeah so when we have that reference document and what I can do is put th those links in the um actually I can put them in the chat for you guys right now I think um when you have those the reference for the claim um the claim remark and adjustment codes what it helps you do is decide what needs to take place for the steps to resolve your claims because your claim denials because what I tell you right now if you have is something like a vague denial like a co6 and you're in a specialty a specialty where there is a very clear line of explanation that's showing up under your reason code Your solution or your way to resolve those denials is going to be completely different than someone else in a different specialty okay all right so here's what I want to quickly go over just a couple of some of these top denials here so my friends who are well let's talk about some more anticipated denials first because I keep we get a lot of these questions in comments from time to time I mentioned already c44 your prompt pay disc discount oftentimes practices will receive fax request requesting it let's say if a doctor is out of network with a plan they might request that you reduce down the um the liability for that particular patient's outof Network claim and you sign off on that you send it in and you now have accepted a reduced amount for your claim to be paid faster that's typically what that message communicates when that happens they will most often indicate that that you've taken this kinds of discount with a CO 44 and that is like our zealous payment system where zealous also is an electonic method of payment they either pay you by those virtual credit cards or you can pay for direct deposits in both scenarios they are a third party and receive compensation for their services based on the fee that they take all right and because of that because they are speeding up your payment process not waiting for a check and your administrative burden of depositing that check they also apply a c44 CO 44s are not something that you need to concern yourself with all right you don't need to write off excuse me you don't need to work on appealing those they need to write those off because they are typically assumed denials now if your practice is like we don't want to take those reductions and whatever then you need to deal with who is signing off on those things or who signed you up for zealous whole other discussion okay all right same thing we talked about Co 45s you obviously do not want to do anything with those they're assumed or anticipated denials and then our sequestration that c253 a lot of people are still confused about this reduction in federal payment it's it is a part of the federal government applying a reduction to the federal claims as a almost think of it like a tax right it's something that we have to take so you are making sure that that's written off there's nothing that you can do about the co 2503s okay so those T the the those three denials are just ones that I wanted to give examples of to you guys that might be brand new because we've had people ask questions about those in the past all right so let's talk a little bit about our denials that we know we're going to be taking action on ones that we receive that we know for a fact are going to result in us doing something else what that something else is will likely depend upon the remark code that's present and your specialty right if you're you're a surgical practice and you did not submit operative reports and you receive a co6 denial you probably have a comment code that says the operative report was not present however you may not but if you know a carrier that always sends a co6 you've learned based on past experience with that carrier that they always send a co6 because you forgot to file the operative report then you know what the next best best step to take is okay so your c50s are non-covered services that are deemed not a medical necessity okay co50 the CL the claims are saying these are non-covered services and they are being deemed not a medical necessity when we have a question of medical necessity in all instances the next best step is to request or file medical records with the insurance company for an appeal all right unless it is true and I say that because so many people will do this thing where they want to go out and they want to fight and they want to do but they don't even know what they're fighting for this is where I would suggest that you if you are a coder yourself or you have a coder at your dispose you need to have that Cod or scan the documentation against what was filed on the claim because often times you are missing a diagnosis code that was supposed to be present or in a particular scenario for your specialty you are not allowed to Bill a particular service for reimbursement all right when I say that it's I can't really trying to like I'm blanking on a good example and I should have written that down um but if you have a specialty that says um that that you are not able to provide a particular type of service in conjunction so thinking like bundling right you aren't allowed to provide a particular type of service in conjunction with another service right for the same part of the body right if you have that kind of denial sometimes we will see something like a CO um 50 because they're saying this isn't necessary you guys are creating this additional claim and now it's an administrative burden to the insurance company you need to write it off that's essentially what they're saying now a coder in some cases can tell you if the documentation supports what was build however you have to then consult what the contract says because there are also this is the problem with coders that don't have a lot of payer specific experience if they are not familiar with the policies of the insurance carrier they will not be able to give you enough information to help you decide whether this particular denial is appealable okay this topic can be quite expansive because your specialty is going to drive where I go next so I have trouble having this conversation without taking you guys during us down a certain path with me of a specialty and I don't want to close out those who are in different Specialties so I'm going to continue this kind of more broad stroke conversation and hope that um you guys can make use of it so please feel free to to weigh in on things that you think has worked for you I would love to to hear that but when we know that we have non-covered services for medical necessity if you find that medical necessity was present or was proven in the documentation or you have sometimes they file a co50 because the primary care provider did not provide a referral for the service that sometimes does happen you can some you can see if they picked the wrong primary adjust M code by looking at the remark code as well and just determining whether or not it's as a result of them H not having the referral so this is the the concern with some of our claim adjustment reason codes is sometimes the soft the softwares this is the insurance company's um processing or adjudication tools don't apply the proper claim adjustment reason codes and when that happens it confuses us and we think oh medical notes and we start sending medical notes when we need to look at those remark codes we might find that oops they put this code that said medical necessity but really it was because the authorization or the referral wasn't present okay so I I really can't hope I've beaten that to into your into your hearts your minds today because I really want you guys to understand if you have not paid attention to your remark codes you're probably missing out on the majority of the support that you can um leverage to be able to help decide where to go and to resolve your claims um claim denials all right so um co16 we talked about the same thing goes there this is a very common denial co6 is like people sending messages that are like oh co6 I don't know what to do they're just all it it is g to boil back down to your remark codes and then you becoming familiar with your payers guidelines and your specialty because there are some instances where you might have to have a particular field completed um and I will kind of explain this in a in a very broad stroke you might have to have a particular diagnosis code for a specialty right if you're in a specialty that says we must have this primary code to be able to support the need for X service that primary diagnosis code needs to be there on the claim first in box a or at least linked as as a a primary code that's linked to the service that you're build right on the line item so diagnosis pointing to that service itself okay the other things that sometimes happen is with Medicare A lot of Medicare claims have very with Specialists have very specific requirements on boxes that we may not ever touch in other Specialties or other with other payers so it's important to know what the rules are for those claims and here's the deal Medicare actually does a pretty phenomenal job on their education side so if you visit the CMS website and look for your Specialties guidelines I guarantee you they are going to spell out for you what is required and when I say CMS website you also want to check your local Medicare administrative contractor or your local Mac right which is the company that you are filing with that is going to also apply their own own LCDs or their local coverage determinations if you look at all of that information and apply it to your unique specialty it will help you understand whether or not you are missing something from a claim all right other thing I'd like to suggest my folks who are brand new in practices if you have not looked at previously filed claims that were paid you are missing out on an opportunity because you need to understand what changed if you're brand new and you were you're the one who's creating these claims and filing these claims now right you're the one who is is managing the billing now but there was some your predecessor you didn't overlap with them and you never had a chance to be trained by them you can still look at what they did if you have access to the system you can see the past claims and I literally mean look at the claims if you see the claim was paid for this patient with set insurance company you want to review that claim and see what could be different from this claim that got paid to this claim that got denied not saying that you want to go out in there and just go change a claim and Fiddle with it no you want to have an understanding of perhaps something procedurally has changed maybe along with you joining the practice a new provider joined the practice and that provider is not using the right diagnosis codes or the right procedure codes right maybe the insurance company requires a particular hick piix code in lie of a CP code right or maybe it requires a particular modifier be used instead of a typical so a modifier that indicates right and left rtt instead of a typical modifier that might be used to separate or to indicate that this particular claim is allowed to be buil separate or was unbundled okay so it's important for you to know what are the little nuan es and the differences that might have changed if you're a brand new practice you might have some time more time researching with your carriers trying to match that information with your with your coders as well or you know getting some coding advice that that has to be matched with the carriers I have to continue to say this reiterate this because a lot of coders learn from coding textbook coding to coding guidelines alone and do not know your unique carriers guidelines and it's not a common thing that they're required to know both but it is helpful when you have someone that knows both okay let me quickly look at the comments because I have something blocking my screen so okay let's see hey yes Amy Says Yes check your ncds n DCS and LCDs that's right and um you want to pop that in the um in the chat there um Amy would you see if you could find an example like site maybe from one of the local carriers or like spell it out for them those actually I think I think on the on the Medicare website CS website it has a section that says in in in DCS and LCDs to break it down I think so that's amazing so a this is so sweet thank you so much Local 11 that is so kind of you thank you for that um what do they call that this is like a Super Chat thing thank you for that tip that's amazing I'm so happy that you are learning on the Fly that's amazing so let me know where where you need more help I actually know lot about PT so I could make more videos PT related if you need them all right my friends um so and Amy's gonna hopefully look in there and find us some n DC and LCDs because if if you guys want to kind of get a sense of what that looks like I think it would help you um quite a bit all right okay so um so we talked a lot about R co6 and R co50 let's briefly touch on um a co co 17 I'm giggling a little bit because this is one of my favorite you know requested information was not provided or insufficient or incomplete is what co7 says and when they choose to put these cosos that have the contract um adjustment codes that have such vague language I'm gonna always always remind you guys to look at the Remar codes because a co17 could very well be something simple requested information was not provided in insufficient or or incomplete it could mean that you were missing something vital on the claim form that's required so as we talked about something maybe the diagnosis code was missing like things that maybe your system isn't properly checking right and you possibly are supposed to file a referral number or an authorization number on your claim form that's not present all right even though they have other codes out there that say authorization not present sometimes not sometimes many times these carriers pick the wrong code so again if there's a Remar code look at that it could help it I say the remark codes a lot because there are so many companies in all of my years I'm working with big denial teams so many companies have this knee-jerk response to pick up the phone like big denial teams that just work denials and they are on the phone getting information that is already on a remittance that already says on the remittance exactly what is wrong with the claim so I'm going to keep reiterating to look at your Remar codes because something like a vague requested information was not provided or insufficient could just be that you need to take the steps that are required for your specialty making sure your authorization is present making sure that you have um a uh a proper date of birth for a patient that's a child like I know it sounds strange but sometimes they they link the wrong information um on those denial codes all right sorry keep clicking on the wrong thing okay so um let the next is co19 this is a very easy fix my co1 19ers this is a work related injury or illness thus is the responsibility of a workers's compensation carrier this says Co this goes back to what I had said to you before about making sure your systems are set up correctly it says Co which says contract obl obligation if your software is set up to write this off you will not know that you were not paid properly for that service until someone does a deeper audit to see that the whole visit was written off co19 just means that we now patient maybe didn't give us the proper billing information or didn't mention that they had this work related um injury and we need to get the workers's compensation information so in this instance we could go back to our patient to try to obtain that information and hopefully get those claims refiled with a proper carrier so yes the claims would get written off by that carrier that was built improperly but you want to refile the claim to the correct carrier okay all right so co29 co29 the claim filing limit has expired or the time limit has expired so and it says time limit for filing has expired is typically a a blanketed denial that says that you didn't send that claim in time you didn't send that claim quick enough for the insurance company to consider it all right just a note if you are not filing your claims fast enough and your fastest um your shortest excuse me timely filing limitation for your carriers is like 9 0 days then you got to go back to these previous videos that we've been doing because you're missing something important in your patients workflow when they're first getting started likely or when things are first getting set up for billing there's something that is broken all right and a lot of these denials we'll talk about this a lot in in denial management these denials are great for Illuminating problems that are intrinsic that need to be fixed things that are at their root causing you these denials that need to be fixed at the root you have to go back to the root cause and try to remedy it otherwise you're going to keep having these types of denials co29 whenever you see a lot of co29 and you're new toour practice you right away need to know that something is probably broken on the front end of the revenue cycle before the claim is even getting out the door somewhere it's getting trapped it's getting stuck okay and us as billing companies we struggle with co29 because it's our job to find them but we sometimes can't and it's hard to prevent them we can't always prevent them and here's the deal is it's it's important that we take responsibility for the need to continue to continue to educate and inform the front end when they're missing steps all right our patients that are coming in as reactivations or reactivating old patients if the front end is not confirming the patients insurance and we already have an insurance on file and you file that claim and then you refile that claim and then you correct something and you think oh it's just because the date of the patient's name was Tom and and it's really Thomas you know like you're correcting all these arbitrary things when you finally get your denial from said insurance company let's say it was siga you get that from Signa and they're like oh we got your claim no this patient's coverage is no longer valid right you're like oh shoot and then you look back and you're like oh this patient hadn't been in for a big gap of time let me reach out to the patient and see if they have a different insurance company you call the patient like oh yeah I have United Healthcare oh God United 90-day timely filing all right so we say United Healthcare are like okay great send me the information now signal situ ation for you to get that claim resent to Insurance just to get the the confirmation that they didn't even have coverage the Signa anymore took you four months to figure that out and now the patient gave you United healthc Care information and you're like oh let me just put it in and send maybe they won't notice the hope and pray method um they're gonna notice because it's programmed in their system they're going to notice and they Deni for co29 what can you do you can in most cases send a proof that you filed to the incorrect payer you filed to Signa because the patient provided you with that information and then you found out it was supposed to be filed to United not every carrier approves these types of denials approves these types approved these types of reconsiderations meaning you've asked them to reconsider what they processed but there are are a lot of companies that do so be prepared to still use your claim acceptance report from the primary or the other company that you build so in my example Sigma I would use that claim acceptance report as proof of timely filing and file a reconsideration explaining the scenario don't just say oh the claim was filed to in time and what they're going to be like no it wasn't that's not us like you got to explain why you sent what you're sending and let them know that you know it was our intention however our patient came back and let us know that we had the wrong information down the road now the truth is this administratively it is your responsibility to have the workflow right when your patient comes in you should be asking for that card and comparing it against what you have so not don't expect them to just kind of be like oh no big deal we understand every time you have to fix what's broken on on the front Okay you have to fix it something wrong with what's what's going on in the front then all right let's see I love this yeah oh yeah this is yay awesome that's funny guilty of that one yeah there's so many of us that are there's so many of us that are and then Amy sharing a link and is that Amy is that the the the link for the um for the ndcs and ldcs I just want to make sure that people have um an understanding of link that is out there so that they don't think that you're just putting out a a random link that might get them some ickiness for their computer by the way Amy is on my team as well now welcome Amy to the team so that's why I'm talking to her so casually um so and I trust the link that she would put out there um just so you guys know that all right so um here we go patient type of denials and I will say that in air quotes because when we look at the the the um way that the claim is being processed there's a lot of practices out there that do this thing that they just drop the statement to Patient there's a lot going on here you now have potential that you won't ever catch the the denial that could be fixed easily in time there's also this thing that you're now upsetting your relationship with your patient which you know no one likes that you would just kneejerk to send them a bill no likes that all right and then you have the potential that you will um lose did I say that the beginning yeah lose you lose track of your denial and you have the potential that you won't even notice that this denial came in in the first place right I guess it's like a reiteration of the first one um there was there was a third and it's just out of my head right now um but essentially there are PRS that come in PRS are those patient responsibility denials that you could on your own without patients in um involvement remedy and I say that kind of with a little bit of um fine print that it really depends upon your workflow right if you properly have um the scaned those cards in but nobody updated the information or um you are billing a patient's Medicare policy little bonus you can actually check Medicare records and get the patients updated information or their new supplemental and all of that stuff without having a copy of your patient information if you had their original Medicare number and you now need to know what their Medicare um Advantage plan is or that replacement plan what plan is replacing the Medicare coverage you can get all of that through the Medicare resources online all right so you don't really need to have a whole lot of interfacing with your patients okay so try not to jerk oh I'm sorry the last thing that you're doing when you're is is that you are incurring the expense to send them these statements you are wasting money like why there's so many people that have these systems that just automatically drop it to patient and the patient just get bills like clockwork and every single one of them gets return and then you know they're escalating them to collections or whatever like nobody no one cares that you're sending them collections for $75 like nobody nobody cares about that all right I I'm gonna keep saying that because it's real like there are so many companies out there that will lend patients for all kinds of things with medical debt because we have we're we're in a such a state in our country where medical debt is just a thing all right and we all deal with it right we've all dealt with it and so it's everyone understands that if you explain it in a letter that no big deal okay so the types of denials that we have that are PRS that are most common that you guys can resolve are your PR 26s which is the expenses incurred prior to coverage your PR 27 which is expenses incurred after coverage was terminated basically both of those things say that the patient didn't have any coverage with that carrier so pr26 says that they that you build the claim to an insurance company before it came into effect so the data service happened before the claim um excuse me before the insurance carriers coverage was in effect okay the pr 27 says the opposite right you build the claim after the date of after the the Ser the gracious after the coverage terminated your data service took place okay so they're just the reverse but saying the same thing which means that the patient did not have coverage when you get those PRS 26 or 27 you are going to want to look to see if your patient provided an insurance card at that time of service that perhaps someone just did not update it happen happens so much because we spend a lot of time and even on this channel we've talked a lot about your data capture for your new patients but we haven't really spoken a whole lot about the reactivated patients what about the people that came back after not being there for months or even sometimes years what is your workflow for those people and who is going to be the one to kind of make the updates to those patients right we need to make sure that we potentially are doing the same thing you know we looked at the new patient log you're doing the same thing for people that are coming in with changes of insurance that you're making sure that the verifications or whatever needs to happen with your specialty are done and then that you were updating their patients and that the claims are going out and getting paid right so that was what we did with our new patient log you can do the same thing for your reactivated patients or your patients that are are um are coming back in after a period with new insurance okay um this this is very important because we're about to come into a new year we will have a whole section of discussions about try to make how to make this new year um a really strong one for my people who struggle with these kind of New Year resets there's a lot to be done for the new year and um a lot of people don't have a process for what to do the the what to say even to your patients as they come in at the start of the new year you have to implement a script for that new year otherwise you're just going to be losing money left and right okay all right so um pr28 coverage not in effect at the time of service that that the service was provided I'm sorry I should have mentioned that those three are the same 26 27 and 28 all just mean the patient did not have coverage they did at some point but they don't have coverage now all right PR 31 is patient cannot be identified as our insured now I will say this pr31 could mean that yes you build the wrong insurance or it could could mean that something is wrong with the patient's demographic information maybe the date of birth is wrong maybe the ID is a little off maybe you spelled their name instead of putting Tom or Thomas you put Tom and the insurance company is not matching that patient's identity okay doesn't mean that the patient should be receiving a bill because it could be something that you could correct it means that there's it could mean that you have something that you've done with your um initial data entry or data capture when you've grabbed that information to create your claim that you don't have correct okay same is true for um pr32 it could be a similar scenario as pr31 but it also could mean that you potentially have a patient situation this one I'm sorry says our records indicate this patient is not an eligible dependent it could mean that you um obtained the the parents billing information like let's say the P the patient came into a family medicine practice and patient mom came in with child and you thought insurance was the same for child and Mom but no child has insurance with dad's company and you build Mom's insurance company okay so it's another way for them to say that this particular patient does not have coverage but you your scenario could be unique that you might have Dad as a patient as well and you could very well just swap out the information and resubmit it or you're calling patient to try to get or reaching out to the patient to try to get that remedied all right this is all stuff when it comes to patient that could be fixed if you follow those recommendations from the last videos because they're all things that are going to get you eligibility checked check checks done before the visits take place done before the patients leave the office that's the key part is you need to get all this stuff kind of ducks in a row before your patient walks out the door because your likelihood of being able to get in touch with them or especially if you don't have like a text test text messaging ability within your system you probably won't get in touch with your patients I know it sounds bad but so many people do not pick up their phones and if you have to be able to communicate with them through a portal or through some sort of um electronic means securely right to just ask them to call you and that's possible with a lot of text messaging interfaces or patient portals it's harder when you're trying to call them and you're calling from the billing department from an 800 number or something like that all right so um so yes all right um took a little longer than I expected it always does all right so here's what I want to to know I want to know from you guys was that helpful did you have other questions so I like it okay cool yay all right awesome am me says that yes that's an example of one and that's where you can search for any I love it thank you for sharing that awesome all right so I want to know was it was it helpful this kind of very high level discussion of denials when we get back together next time I'm going to group together some denial types and we're going to look at them on the screen I try not to do too much screen share um here when we are on these lives because you guys don't talk as much when when I do screen share but I think it's easier at certain in certain things like this discussion so next time I will pop some of these codes on the screen and we'll talk through the types of denials and things that I'll group together so ones that we know for sure are patient related or ones that we know for sure are um insurance coverage related or pre-certification related so you understand that even though it says such blanketed language it really means that an authorization is is missing right so and once more my scenario might be different than your scenario right but when I see a co1 right a co1 I'm almost always thinking something is wrong with the coding right something is wrong with the modifier potentially or a procedure code that's being used right so those general rules will still be very relevant for you and I want to know what general rules you see in yours I didn't talk about duplicate um claims because that's like general for everything and everybody but um and we we could talk about the ways to save you guys from getting those duplicate Deni so I love it yeah love that thank you hey Carmen good to see you very helpful thank you Local 11 thank you so much yay yeah I'm happy you caught it live too thanks for thanks so much again for that super chat um and my friends who are um here for the first time or just joined um I want to just quickly mention again Nicole just popped it in here all of our courses what you get here on YouTube is great I hope it gets gets you what you need when you're looking for certain things but we do have organized courses that are already out and a lot in the on the docket to be released in these next couple of months and you um will want to take a look at that to kind of get a sense for whether or not there's something out there for you because we have our Black Friday sales happening right now so our courses everything on that site is 40% off right now which means that you will receive 40% off of all of the courses that are for sale or the ones that are in pre-order and if you are looking to commit to taking mastering medical billing in February you can save 40% right if you're take wanting to take the next cpb um Readiness coaching program with me you can save 40% and then I'm also gonna do a little um nudge here for you guys oh me a quick question if the patient has Med oh I love this this is a great question um if a patient has Medicare and TR care for Okay so no it is not say try care for life is it always secondary yes that here Medicare is typically going to be primary try care for life um so and I'm just referring back to the fact that you are PT um you have to be registered fully with Medicare and tri care for life and a lot of um the tri care plans the the tri care plans don't cover a lot for PT so you're probably going to see a lot of Medicare that drops to secondary anyway I mean that drops the claim over to to crossover that gets denied so um I hope that helps but yes you're you're going to see Medicare stay as primary um in a lot of instances you're going to have Medicare as primary uh it's very rarely a secondary um unless the patient is still working all right um cool Linda Yay I'm glad you liked that I'm glad you liked it okay s