Industry thought-leader and revenue cycle management expert, Elizabeth Woodcock, Principal at Woodcock & Associates, will walk you through the main areas that you should focus on to ensure your practice(s) can achieve clean claims this year.

1. © 2021
Elizabeth Woodcock, MBA, FACMPE, CPC
Principal, Woodcock & Associates
What You Need To Know To
Achieve Clean Claims In 2021

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Harbor
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Agenda
• Welcome & Introductions
• Why Are We Talking About This Now?
• Engage The Team
• Recognize The Domino Effect
• Obsess Over Accuracy
• Determine The Workflow
• Conclusion
• How Kareo Can Help
• Q&A

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Supporting Your Professional Development
• PAHCOM has approved 1 CEU credit
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*This program has the prior approval of AAPC for 1 continuing
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6. © 2021
Elizabeth W. Woodcock,
MBA, FACMPE, CPC
• Speaker, Author, Trainer | www.elizabethwoodcock.com
• DrPH Candidate, Bloomberg School of Public Health, Johns Hopkins University
• MBA, Wharton School of Business, University of Pennsylvania
• BA, Duke University
• Fellow, American College of Medical Practice Executives
• Certified Professional Coder
• Author, 17 textbooks and more than 500 articles
• Founder and Principal, Woodcock & Associates
• Founder and Executive Director, Patient Access Collaborative
• Former Consultant, Medical Group Management Association; Group Practice Services
Administrator, University of Virginia Health Services Foundation; Senior Associate, Health
Care Advisory Board
Principal, Woodcock & Associates

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Why Are We Talking About This Now?

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Government Regulation

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Government Regulation
?
https://ccf.georgetown.edu/wp-content/uploads/2021/01/Public-Health-Emergency-Message-to-Governors.pdf

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Workflow Changes
• Email paperwork
• Patient portal
• Online
• Smartphone app
• Kiosk
• Etc…
Where do “clean claims” fit in?

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Fundamental Principle
Unspecified
ICD-10
code
Incorrect
subscriber
number
No
authorizatio
n number
Garbage In...
…Garbage Out!

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Fundamental Principle
Still in your hands
[Edits/Errors]
The
Payer’s
Claims
Adjudication
System
5 to 10%1
less than 1% to more than 50%2
1American Academy of Family Physicians (AAFP)
2Kaiser Family Foundation

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Fundamental Principle
Source: Consumer Report Card On Health Insurance Carriers In Connecticut - October 2020

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Fundamental Principle
Edits/Errors
Denials

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How can we solve for this?

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 Engage The Team
 Recognize The Domino Effect
 Obsess Over Accuracy
 Determine The Workflow
 Conclusion

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Engage The Team

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Engage The Team

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Engage The Team
 Directors of First Impressions
 Directors of Denial Prevention
 Directors of Price Transparency
 Directors of Point-of-Service Collections
Directors of Clean Claims

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Recognize The Domino Effect

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Recognize The Domino Effect

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Recognize The Domino Effect

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Recognize The Domino Effect
• Staff resourcing
• Cash flow
Source: The Physician Billing Process: Potholes in the Road to
Getting Paid. 2016. Includes staff, resources and interest.
Actual Cost of a Denied Claim

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Recognize The Domino Effect
Aging returns to ZERO, but the probability of payment is cut in half

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Obsess Over Accuracy

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Obsess Over Accuracy
Medication Reconciliation

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Obsess Over Accuracy

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Obsess Over Accuracy
24 to 72 hours

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Provide Business Intelligence

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Determine Workflow

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Determine Workflow
Insurance Coverage
Benefits Eligibility
Financial Responsibility
Financial Clearance
Unmet Deductible

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Determine Workflow

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Determine Workflow

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Determine Workflow
Impact on time to
schedule?
Impact on patient flow?
 When?
 Scheduling
 Pre-Visit (i.e., 2 to 3 days prior)
 At The Visit

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Determine Workflow
https://x12.org/codes/claim-status-codes

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Determine Workflow

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Determine Workflow
Select a Physician (or APP) Champion
Share denial report with your Champion and the “Directors
of Denial Prevention”
• Volume
• Dollars
Consider engaging the team to work the denials
• Individual
• Rotating responsibility
Incorporate accountability into annual performance
reviews

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Conclusion

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More Best Practices!
Focus on Patient Experience
• Get It Wrong  Patient Loses
Offer Team Incentives
• Wear Jeans for a Day; Give Time Off
Create Clean Claims Certification
• Develop a Basic Skills Test  Certified!
Introduce A New Title
• Patient Access Representative Specialist
Create A Professional Pathway
• Front Office  Business Office

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Conclusion

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Awards and Rankings

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45. Questions
Answers

46. © 2 0 2 1 K a r e o I n c . A l l R i g h t s R e s e r v e d .