by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
November 29th, 2016
Use this tool as a part of an important strategy to improve your processes and stay ahead of denials. Check your most commonly used codes to give your practice a heads up on denial rates and average charges. This is a quick way to view a group of codes or a single code showing denial rates and average charges on claims submitted to Medicare using the last 8 years of Medicare data.
Once you gather your codes do a self audit on the codes showing the highest denial rates to see how you are doing.
Here is how…
Enter your codes in the Box, chose the year you wish to view, then chose your specialty or National Average.
Now export your data to a Excel/CSV file and sort the column showing the percentages of denials. Now focus your attention on the codes with the highest denial rates and compare the data with your claims.
|Code Set||Code||Descr||Denial %||Average Charge|
|CPT||11313||SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM||50.00%||$217.86|
|CPT||15040||HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<||42.00%||$620.04|
|CPT||11055||PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1||14.00%||$67.74|
|CPT||99214||OFFICE OUTPATIENT VISIT 25 MINUTES||7.00%||$167.78|
|CPT||99212||OFFICE OUTPATIENT VISIT 10 MINUTES||6.00%||$70.51|
|CPT||10120||INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE||5.00%||$211.04|
|CPT||11760||REPAIR NAIL BED||5.00%||$279.91|
Compare your fees to ensure you are receiving proper reimbursement.
How are your codes are being paid – where are the denials coming from?
- Incorrect Patient Information?
- Incorrect Provider Information?
- Incorrect Insurance Information?
Use this Find-A-Code exclusive tool as a part of your Denial Management!