Denials: Take advantage of reporting functions

Tuesday, March 27, 2012

David Letterman's Top 10 lists are humorous--this one's just the opposite. Sarah Hanna will return to Medtrade Spring with her list of the top 10 Medicare denials and her best advice for curtailing those denials in the future. Here's a preview:

HME: What's one of the top denials to make your list?

Hanna: The one that shows up a lot is the 151 denial with over-utilization of supplies. This happens a lot with diabetic supplies. The patient calls for more supplies, the intake people let it go out, the biller doesn't check the quantity and then the denial comes back. 

HME News: How can a provider reduce 151 denials? 

Sarah Hanna: You have to train people to take the time to look at the history to see what they have received and get the ABN on over-utilization of supplies. If we know it's a medical necessity, put it into the NTE field and give a summary of why they require it.

HME: Does a denial like this one usually catch a provider by surprise?

Hanna: It shouldn't if you're running data reports. People don't use reporting functions because they don't get enough training. People get updates but they don't know what it means.

HME: What responses do you get from providers about this message?

Hanna: They say, "Oh, I know I need to do that." Or they say, "I don't have time to train." I appreciate that. To train, you have to spend money. But you'll spend money to save money. 

HME: What goals should a provider set for their denial rates?

Hanna: Depending on where you are when you start, your goal should be to reach 10%. Work on 5% every week over eight weeks. It takes time to see the fruits of your labor. Once you hit 10%, it gets harder to continue to reduce that.