Medicare Denial Tracking
Medicare attaches many rules to claims processing, causing hundreds of possible errors. If a diagnosis code, NPI number, service duplicate charge or other modifier is missing, Medicare will kick the claim back to the hospital for rework before billing.
For Phoebe Putney Hospital, this represented some 280 pages of errors. The Medicare patient account rep at Phoebe Putney, would have to extract files, put them into an Excel spreadsheet and then correct errors and omissions, or make additions. She wasn’t able to keep up with the hundreds of incoming batches of error sets, and by targeting ten with the biggest return; she could process 150 claims per day.
Reese Walker, lead financial systems analyst, realized they could get more done and speed reimbursement if they automated the claims review process. Walker became familiar the various steps of the workflow and used Boston WorkStation to automate the job.
After using a data mining tool to sift through the failed claims reports, Boston WorkStation automatically compares data, makes the required corrections to claims and produce a report showing claims requiring human intervention. By automating this critical workflow, Phoebe Putney can now process 300 claims per hour. Its failed claims have dropped by as much as $20 million, and the hospital doesn’t need to hire additional full-time employees or pull other resources to help manage the failed claims report.
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