Percentage |
Challenge |
Action |
| 5-10% |
The Chilling effect of Coding/Documentation Challenges
Studies indicate that physician self down coding can run $25,000-$40,000 per physician per year because they are unsure if their documentation will stand up to scrutiny, or they want to “stay under the radar”. |
|
CureMD includes “Code-checker” technology to scan your documentation and compare it with the level of service you have selected. If the documentation is not sufficient to support the code you intent to bill, you will be warned, enabling you to complete the documentation, and feel confident enough to bill for the service you provide.
|
|
| 5-7% |
Services provided but not billed
Are all of the services provided and documented getting billed? Some services in the office are never picked up for billing and services in the hospital may be lost, or not documented to be billed by the office.
|
|
CureMD’s Practice Management System scans your medical record documentation and “sweeps” all services provided over to your billing, eliminating lost charges from your practice. |
|
| 6-15% |
Timely filing denials
Reports obtained by CureMD show a range of practices that have issues with getting claims submitted on time.
|
|
CureMD’s “Intelligent Billing” technology submits your claims daily, and obtains receipts that your claims have actually been received by the payer, documenting your compliance with submission requirements.
If for some reason your claims are not accepted, CureMD’s dashboard will highlight the problem as it occurs, so that you and your staff can address the problem, before the problem costs you loss in revenue.
|
|
| 5-15% |
Rejections not corrected and re-submitted
10-30% of claims initially submitted are rejected. 50% are not resubmitted or not submitted on time.
CMS data shows a rejection rate of 26% with 40% of rejections never resubmitted.
Others report national rejection rate of between 30% and 55%, with 18% at the lower end and, with 50% never re-submitted.
|
|
CureMD Intelligent Billing™ technology identifies rejections when submitted, not days or weeks later, and keeps those rejections prominent on the revenue management dashboard for ready identification, and prompt correction. |
|
| 3-7% |
Denials not appealed
50% not appealed. Appeal approval rates can run as high as 70%.
MGMA reports the average denial rate as being 7%-14%.
42% of practices in a national survey don’t know what their denial rate is.
Physician Practice Magazine reports a 10% denial rate.
|
|
CureMD identifies denials as they are received, and places them prominently on the revenue cycle management dashboard for intervention by yourself and staff, giving you time to press the payer for your payment, or promptly pursue the other responsible party. |
|
| 6% |
Payments less than the allowable
Many practices do not audit their paid claims to make sure that they are being paid the contracted rate. |
|
CureMD subscribers get Right-Remit™ to automatically verify allowable charge and manage appeal latter generation. |
|
Up wards
to
60% |
Total POTENTIAL Lost Revenue |
|
Note: Some claims lost are in multiple categories above. For example the denial that is resubmitted, rather than appealed is eventually denied for timely filing. |
| |
|
