Dealing with Rejection

Three Tough Questions for Your Current Medical Billing Company

Rejected claims affect the financial performance of your medical practice by extending the payment cycle and negatively impacting cash flow. Consider how your staff or your current medical billing company is managing rejected claims:

You want the reassurance that comes with knowing your medical billing company follows timely and thorough procedures for handling rejected claims. You deserve a partner that will pursue your rejected claims relentlessly.

Hawthorn Physician Services offers a thorough, tested, integrated approach to reducing rejections and managing rejected claims.

We Minimize Rejected Claims

Rejected claims are not the same as denied claims. While denied claims have been received and processed by the payer’s adjudication system, rejected claims have not been processed. Rather, rejected claims are returned unprocessed because they have failed to meet basic data requirements, such as correct patient information or correct codes.

At Hawthorn Physician Services we follow proven processes for making sure claims are submitted correctly the first time, with accurate coding and patient demographic information, and our diligence has produced a 98% acceptance rate on first time claims. We also excel at correcting and resubmitting rejected claims to avoid further delays in processing.

We Generate Faster Payments

Most claims at Hawthorn are received and processed electronically, and claims are sent to insurance carriers within 48 hours. The operation starts when we receive diagnosis and treatment files from hospitals and medical practices. We convert those files to claims by matching patient demographics, and by verifying CPT-4 and ICD-10 codes. If a coder needs more information to code a report correctly, we will contact the physician or the hospital directly.

Hawthorn’s approach generates faster payments by minimizing rejected claims and reducing the time interval for resubmitting rejected claims.

We Submit Cleaner Claims

We use two claim scrubbers to ensure clean claims. Our customized billing application includes Coding Editor software that compares client data to the appropriate Local Medicare Review Policy (LMRP) to verify that claims are accurate and complete.

Our coding application is superior to other systems because of its flexibility. Edits can be performed before procedures are posted, and edits can be completed on an existing transaction across any date range of transactions. Thus, the system recognizes inaccurate coding during initial entry rather than during claims processing, and claims are reimbursed faster due to the elimination of incorrect codes.

A second front-end scrubbing and editing application is located within our electronic insurance clearinghouse, Navicure, which captures any medical necessity and bundling issues that might require follow up or correction. Navicure also accepts edits, and Hawthorn requests front-end edits continuously and as required. Rejection reports from Navicure provide user-friendly descriptions of errors needing modification.

Errors on rejected claims are received from Navicure with 24 hours of submission, and we make corrections and refile rejected claims daily. We use websites and online accounts provided by major payers for verification purposes, and we track the status of all claims. Our goal is to avoid claim denials due to late filings, so we use rejection reports to correct and re-transmit claims immediately.

We Capture More Revenue

Our internal electronic claims management software is another component of our follow up process. This customized software supports claim status tracking, so we can review and resolve rejections more efficiently. While we concentrate on the first 90 days of the payment cycle, we take time to resolve payer issues to our standards. In order to capture the largest amount of revenue, we process, file, correct and refile all claims during the first 30 days.

Hawthorn also performs a stewardship role in behalf of its clients. If we see a pattern of missing claim information or incorrect codes from a particular source, we will raise the issue directly with the client. If additional training is required, we will schedule a coding in-service session at the client site.

Hawthorn is focused exclusively on serving hospital-based medical practices. We serve medical practices with average billing amounts in a range between $60 and $400, and we track every claim or patient bill, no matter how small. We retain accounts longer and work them harder, so we recover more revenue and place fewer bad debts with collection agencies. No other revenue cycle management company can match our dedication. We pursue our clients’ bills and claims relentlessly.

The Hawthorn Solution

At Hawthorn we address complexity with certainty. Our approach is based on a set of promises we call The Hawthorn Advantage. The Hawthorn Advantage creates incremental value for hospital-based medical practices.

Our processes are not only more efficient, they also generate big-picture data with insights about emerging trends — what’s working, what’s not working, who’s paying and who’s not paying — valuable information that physicians and practice managers can use to develop strategies for continuous improvement.

To learn how we can maximize your reimbursements, improve your cash flow and increase your profitability, click here.

About Hawthorn

Hawthorn Physician Services Corporation is a privately-held, nationally-recognized healthcare revenue cycle management firm located in St. Louis, MO and currently operating in all 50 states. Hawthorn serves hospital-based medical practices, including pathologists, anesthesiologists, radiologists, hospitalists, emergency physicians, and radiation oncologists, plus office-based specialties, including internists, cardiologists, endocrinologists, wound care specialists, and infectious-disease physicians.

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We improve profits for medical practices by increasing their net collections and maximizing their reimbursements.