How to prevent Medicare claim denials in 5 steps
Health care facilities continue to be plagued by Medicare claim denials, and it’s a problem that continues to escalate in terms of occurrences.
Overall, the increase in claim denials has been found to be linked to health care facilities submitting claims that follow outdated guidelines.
Here are five ways to avoid this from taking place in your institution, or correct it if it already has.
1. Track changes in claim requirements.
You can't properly avoid Medicare claim denials if you aren't informed of the latest changes in claim guidelines and rules.
Assign someone in your facility with the duty of staying current on the latest Medicare changes and ensure that any changes that affect your claim submission process are filtered down to relevant affected employees.
2. Ask for current information.
A proactive measure you can take to reduce the number of Medicare claim denials in your health care facility is asking each patient to present an up-to-date Medicare card.
By asking for current Medicare information, you can verify that it matches the copy in your records and, most importantly, that you have the current information needed to submit a valid Medicare claim.
If patients aren't happy with the change of being asked to present their Medicare information at each visit, explaining that it's a new policy to avoid claim denials should help.
3. Understand provider issues.
According to the article “A basic guide to reducing Medicare claim denials,” many facilities are currently receiving claim denials because a “referring provider cannot order or refer.”
This denial is most typically linked to a 2014 change in the rules from the Centers for Medicare and Medicaid Services.
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This rule change now means that Medicare will deny certain types of supplies and equipment if the ordering or referring physician isn't identified properly or isn't enrolled in certain Medicare systems.
4. Follow up fast.
A common practice in health care facilities is to allow a stack of claim denials to build so that employees can deal with them at one time in bulk. However, this could be hurting your facility.
Instead of letting the denials pile up, set a new standard of dealing with them immediately so you won't forget the details associated with it and your revenue will be less affected in the long term because denials will be resolved sooner.
5. Inform your staff.
Communication is key when trying to reduce the number of Medicare claim denials that come back to your health care facility.
Staff members who submit claims must remain informed on changes in Medicare guidelines and rules. They must also have the training needed to properly submit claims.
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If your investigation into why denials are happening shows that staff members haven't been properly trained or informed on guidelines changes, make the necessary policy changes to correct the situation.
Don't let an uptick in Medicare claim denials affect your health care facility's revenue.
Instead, investigate the sources of the problems, take swift action to correct the troubles and set a new standard for keeping current with Medicare claim guidelines.
About the author: Shayla Ebsen is a freelance writer and editor with more than 10 years of professional writing experience both in the corporate and freelance settings.
Dexcom: changing the lives of people with type 1 diabetes
It is estimated that 9.3% of adults around the world are living with type 1 diabetes, which amounts to a total of 463 million people. A further 1.1 million children and adolescents under the age of 20 are living with the condition.
Unlike the more prevalent type 2 diabetes, where the body still produces insulin and symptoms develop slowly, people with type 1 diabetes need regular insulin injections or pumps, and must monitor their sugar levels frequently.
In recent years a number of remote glucose monitoring systems have become available that patients can use at home. These work with a sensor, usually placed under the skin, that measures glucose levels every few minutes. This information is then transmitted wirelessly to a device like a smartphone or tablet, which can then be shared with their clinician.
British actress Nina Wadia's son Aidan, 14, has type 1 diabetes, and has been managing his condition using Dexcom, a glucose monitoring system used by patients all over the world. Here Wadia explains how Dexcom has improved their lives.
As a parent of someone with type 1 diabetes, what is your day-to-day life like?
Being able to take a breath, think and pivot constantly without getting frustrated becomes an essential mindset because sometimes it feels like each day is determined to be different from the day before. Whatever worked yesterday is going to misfire today.
Which areas of yours and Aidan’s life are most impacted by diabetes?
The one thing that you have to fight hard to reclaim is spontaneity, especially when it comes to food and exercise. It’s only when this is taken do you realise how essential each one is. You can be flexible and there are no real limits, but only in the sense that a great athlete can be flexible without limits because they’ve trained super hard to be that way. So we’ve all had to become athletes when it comes to being spontaneous.
How has Dexcom helped you and Aidan?
Dexcom has brought future science fiction to real life today. The continuous glucose monitoring system is tiny, sits discreetly on his body and gives him a ten-day breather between sensor changes, so it's goodbye finger-pricking seven times daily.
Dexcom is totally active at a grass roots level and for Diabetes Awareness has pledged to donate £2,000 if #DexcomDiabetesStories and/or #DexcomWarriorStories is shared 200 times! I’ll be sharing more on social media and would love to hear how other families are winning their fights.
Maybe most importantly Dexcom is trying to introduce a reimbursement programme for type 1 diabetes patients which will give greater access to modern, life changing hi-tech. I want to spread the word on the importance of accessing it through this campaign.
If you compared your life today with how it was before Aidan was using Dexcom, what has changed?
It's always working, which lets him take his mind off diabetes for longer stretches. It also lets me get off his back. We both receive alerts so I no longer have to pester him by asking him what his number is, and especially importantly, I don’t have to wake him at night to prick his finger if I’m worried. Dexcom gave us back our sleep!