When we get a new client, we always offer to look back over the prior year’s Medicaid billing. Often, we find income they are due by reviewing coding of claims, their management of authorizations/utilizations and checking error/reimbursement-denied reports.
If the provider has a software program, we review:
- all partial paid or unpaid claims (why weren’t they paid in full?)
- claims with non-billable codes (why didn’t they get submitted/billed?)
- over-utilized claims (are there possible issues on the County Board side that can be fixed?)
- pending claims (why aren’t they authorized?)
If provider doesn’t have a software program, we review:
- provider weekly reports
- error reports
- reimbursement denied reports
We do additional research to determine why the claims were rejected–in hopes of resubmitting for payment. We also compare acuities billed to acuities per DODD’s Individuals Served Report in the Data Warehouse, to be sure revenue is maximized.
For a recent new client, we found $37K in lost revenue!
Checking over your past year’s billing at the New Year is a great practice to get into.