Denial Prevention Coding Review

Denial Root-Cause Analysis · Purpose

• Find the root causes of claims denials and develop remedial action strategies.

Denial Root-Cause Analysis · Services Include

• Trend analysis of historical denial
• Claim rejection pattern identification
• Investigation into denials related to coding
• Analysis of gaps in documentation
• Payer-specific denial assessment
• Review of workflows for providers
• The identification of leakage revenue

Denial Root-Cause Analysis · Denial Categorization

• Coding errors
• Documentation deficiencies
• Problems with authorization
• Failures to meet medical necessity
• Modifier errors
• Questions relating to eligibility

Denial Root-Cause Analysis · Benefits

• Reduce repeat denial patterns
• Improve the acceptance rate of claims after first pass
• Recognize operational weaknesses
• Create data-driven denial prevention strategies

Coding Correction & Claim Optimization Review

Purpose

• Correct coding inaccuracies before claims impact reimbursement.

Coding Correction & Claim Optimization Review

Services Include

• ICD-10-CM diagnosis code validation
• CPT procedure code verification
• HCPCS Level II review
• Analysis of code sequencing
• Validation of the relationship between diagnosis-procedure
• Review of unbundling and bundling
• Review of compliance to the latest code update
• Annual coding guideline updates

Coding Correction & Claim Optimization Review

Focus Areas

• Incorrect diagnosis selection
• The diagnosis is not being followed up.
• Coding error due to incorrect procedure
• Unsupported services
• Incorrect code combination

Coding Correction & Claim Optimization Review

Benefits

• Accurate coding has been improved
• Payer disputes are less frequent
• The clean claim rate has increased
• Better reimbursement outcomes

Modifier Review & Validation · Services Include

Avoid denials due to modifiers that are caused by improper usage or a lack of documentation.

• CPT modifier validation
• NCCI Edit review
• Global surgery modification analysis
• Bilateral procedure review
• Multiple procedure modifier review
• Telehealth modifier review
• Assistant surgeon modifier review

Modifier Review & Validation · Benefits

• Reduce technical denials
• Increase the compliance
• Prevent incorrect reimbursement adjustments

Medical Necessity Review · Purpose

• Make sure that the services you pay for meet the medical necessity of the payer.

Medical Necessity Review · Services Include

• Evaluation of the clinical documentation
• Matching of diagnosis-to-service
• Validation of the Coverage Guideline
• LCD/NCD guideline review
• Review of compliance with the Payer Policy
• Recommendations for improvement of the documentation

Medical Necessity Review · Review Areas

• Diagnostic tests
• Services for imaging
• Procedures
• Specialty treatments
• Management of chronic diseases
• Services to prevent disease

Medical Necessity Review · Benefits

• Reduce denials of medical necessity
• Strengthen documentation quality
• Increase the rate of approval for payers

Appeal Documentation Support · Purpose

• Help healthcare institutions recover the revenue lost from claims denied.

Appeal Documentation Support · Services Include

• Denial document analysis
• Identification of appeal opportunities
• Coding justification preparation
• Review of clinical documentation
• Letter of appeal support
• Supporting evidence-based organization
• Payer-specific appeals and recommendations

Appeal Documentation Support · Appeal Types

• Appeal related to coding
• Medical need appeals
• Appeal to the document
• Authorization-related appeals
• Bundling appeals

Appeal Documentation Support · Benefits

• Increase the success rate of appeals
• Recover lost revenue
• Reduce unresolved denial backlog

Payer Trend Analysis · Services Include

Be aware of the behavior of your payers and take steps to ensure that no further denials occur.

• Reporting on insurance-specific denials
• Monitoring of Payer Policy
• Trend analysis on the cause of denial
• Tracking reimbursement change tracking
• Review of contract performance
• High-risk claim identification

Payer Trend Analysis · Supported Payers

• Medicare
• Medicaid
• Medicare Advantage Plans
• Commercial Insurance
• Employer Health Plans
• Managed Care Organizations

Payer Trend Analysis · Benefits

• Predict future denial risks
• Enhance the strategy for payers
• Improve the performance of the revenue cycle

Data Collection · Receive

• Claim data
• Medical documents
• Denial claims
• Payer correspondence

Coding & Documentation Review · Analyze

• ICD-10 codes
• CPT codes
• HCPCS codes
• Modifiers
• Medical need

Root Cause Identification · Identify

• Coding concerns
• Documentation gaps
• Payer-specific developments

Corrective Action Plan · Provide

• Coding-related recommendations for coders
• Provider education
• Improvements to workflow

Continuous Monitoring · Deliver

• Monthly denial reports
• Trend analysis
• Performance dashboards

Reduce Revenue Leakage · Impact

ZechionMed aids healthcare providers in identifying potential denials to avoid before money is lost.

• More accurate reimbursement
• Rework of claims that is less time-consuming
• Increased cash flow

Access Certified Coding Expertise

Our experts in coding assist:

• ICD-10-CM
• CPT
• HCPCS
• Modifier rules
• Medicare guidelines
• Commercial Payer policies

Lower Operational Costs

The outsourcing process eliminates the necessity:

• Additional internal teams of coding
• Training expenses continue to be incurred
• Investment in technology
• Infrastructure costs for managing denials

Improve Compliance

ZechionMed supports:

• HIPAA compliance practices
• Coding guideline compliance
• The accuracy of the documentation
• Audit readiness

Advanced Analytics Capability

With the help of technology-driven solutions:

• Denial dashboards
• Trends in report
• Risk identification
• Monitoring of performance