Revenue Cycle Department (RCD) Monthly Reports for Starling Practice Managers
Starting in April 2016, the Revenue Cycle Department began working with Starling practice managers and staff providing monthly information about Coding Edits, Coverage Denials, and Insurance Registration Errors in the effort to improve coding accuracy and decrease claims denial rate for coverage. Reports are being send via email to each practice manager and also discussed during Denial Trends Review meetings on a monthly/quarterly basis. The data collected is helping to identify opportunities for improvement and is used to work with charge entry and front desk team members to provide necessary help as well as education. Decreasing the coding and insurance registration errors will positively impact revenue collection and metrics.
Coding Edits Report
The Ingenix Coding Edits report provides information for different categories of coding issues identified for the previous billing month. The report is separated by each department with number of the charges and charge gross dollar amount. The GH branch charge submission process has been historically done by each department and the coding edits report information is currently reviewed monthly only with GH branch practice managers.
GH Branch ICD-10 codes Edits Analysis (Five Top Edits March – August 2016)
By focusing on the five top ICD-10 diagnosis codes edit categories we were able to send out helpful coding tips with trends for each specialty. White Plume edits were identified and the tips helped establish easier navigation for the staff. In the first six months (March – August 2016) the coding errors rate for edits we focused on with the offices have significantly decreased (please see GH total results below).
Coverage Rejection Report
The Coverage Rejection reports are presented to practice managers of both CMG and GH branches. Reports are used to identify charges denied for non-coverage for the previous month for each department. Details include medical record numbers, dates of service, place of service, total numbers of charges and charge gross amount (example of the report below).
| Department 1 | Count of Chg Number | Sum of Chg Gross Amt | Count of MRN |
| COVEREAGE TERMED PRIOR TO CLAIM SUBMISSION | 1 | $190.00 | 1 |
| POS: WETHERSFIELD WELLNESS CTR | 1 | $190.00 | 1 |
| MRN: 123456, DOS: 8/9/2016 | 1 | $190.00 | 1 |
| PATIENT CANNOT BE IDENTIFIED AS INSURED | 3 | $987.00 | 1 |
| POS: LABORATORY | 1 | $9.00 | 1 |
| MRN: 123000, DOS: 6/21/2016 | 1 | $9.00 | 1 |
| POS: WETHERSFIELD WELLNESS CTR | 2 | $978.00 | 1 |
| MRN: 123123, DOS: 8/251/2016 | 2 | $978.00 | 1 |
| Grand Total | 4 | $1,177.00 | 3 |
Insurance Registration Error Report
The Insurance Registration Error report is also included with the monthly reports for practice managers for both Starling branches since May 2016 and identify charges submitted for the accounts with incorrect insurance registration information (example of the report below).
| Department 2 | Count of Chg Number | Sum of Chg Gross Amt | Count of MRN |
| Commercial Insurance FREE TEXT address – Incorrect or missing | 3 | $623.00 | 1 |
| POS: LAKE ST NEW BRITAIN | 3 | $623.00 | 1 |
| MRN: 1230000, DOS: 8/4/2016 | 3 | $623.00 | 1 |
| MEDICARE POLICY NUMBER – incorrect or missing suffix | 1 | $25.00 | 1 |
| POS: LAB DEPT STARLING PHYSICIANS | 1 | $25.00 | 1 |
| MRN: 123001, DOS: 8/17/2016 | 1 | $25.00 | 1 |
| INSURANCE POLICY NUMBER is missing | 2 | $80.00 | 1 |
| POS: LAB DEPT STARLING PHYSICIANS | 2 | $80.00 | 1 |
| MRN: 1230123, DOS: 8/23/2016 | 2 | $80.00 | 1 |
| Grand Total | 6 | $728.00 | 3 |
The RCD is providing helpful insurance registration tips to the Starling employees registering patients as they are discovered and emailed directly to staff. This and other RCD information is now available on the ADP portal for easy access for all employees at any time.
Ratio of Coverage Rejection with Registration Errors per Total Number of Encounters
The Ratio of accounts with claims coverage denials and insurance registration errors per number of encounters are calculated monthly for each department. The total MRN count is divided by the insurance registration and coverage verification errors and on average is not more than 1% when compared to the total number of encounters for the month. These errors at the time of service, although a small percentage of the total encounters, still lead to claim processing delay for all Starling practices. (Starling total results appear below).
| May-16 | Jun-16 | Jul-16 | Aug-16 | |
| Coverage Denial MRN count | 273 | 155 | 191 | 185 |
| Registration Error MRN count | 244 | 274 | 222 | 184 |
| Number of Encounters | 75753 | 79297 | 70255 | 78743 |
| Ratio (%) | 0.68% | 0.54% | 0.59% | 0.47% |
Front End Payment Collection
The total amount of patient payments collected at the time of service monthly at each Starling location is being recorded by the RCD. We are using it to monitor the increase of payments collected since implementation of the Over-the-Counter Payment Posting program (OTC) at the CMG locations since March 2016. Data for payments collected is presented to CMG practice managers monthly at the CMG Practice Managers meeting. The OTC implementation for GH offices is also completed in September. Going forward front-end payment collection data will be collected and shared with GH practice managers as well.
There are also other reasons that are affecting eligibility, clinical and other rejections for charges submitted on claims. Reports for non-contractual adjustments is currently in the process to be created and will soon be shared with the practice managers. The RCD will continue to identify opportunities to work with practice managers and staff to improve current billing and data collection processes.