May 19, 2020

How Medicare claim denials can be affecting your medical facility

Medicare
Shayla Ebsen
3 min
How Medicare claim denials can be affecting your medical facility

Has your health care facility recently been plagued by an onslaught of Medicare claim denials? You aren't alone. It's a problem that has been happening more frequently, but what's the cause?

Overall, the increase in claim denials is linked to health care facilities submitting claims that followed outdated guidelines. Here is some insight into what may be causing your facility's increase in denials and how to correct the situation.

Track changes in claim requirements

You can't properly avoid Medicare claim denials if you aren't informed of the latest changes in claim guidelines and rules.

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Assign someone in your facility with the duty of staying current on the latest Medicare changes and ensure that any changes that affect your claim submission process are filtered down to relevant affected employees.

Ask for current information

A proactive measure you can take to reduce the number of Medicare claim denials in your health care facility is asking each patient to present an up-to-date Medicare card.

By asking for current Medicare information, you can verify that it matches the copy in your records and, most importantly, that you have the current information needed to submit a valid Medicare claim.

If patients aren't happy with the change of being asked to present their Medicare information at each visit, explaining that it's a new policy to avoid claim denials should help.

Understand provider issues

According to the article “A basic guide to reducing Medicare claim denials,” many facilities are currently receiving claim denials because a “referring provider cannot order or refer.”

This denial is most typically linked to a 2014 change in the rules from the Centers for Medicare and Medicaid Services.

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This rule change now means that Medicare will deny certain types of supplies and equipment if the ordering or referring physician isn't identified properly or isn't enrolled in certain Medicare systems.

Follow up fast

A common practice in health care facilities is to allow a stack of claim denials to build so that employees can deal with them at one time in bulk. However, this could be hurting your facility.

Instead of letting the denials pile up, set a new standard of dealing with them immediately.

By dealing with a denial right away, you won't forget the details associated with it and your revenue will be less affected in the long term because denials will be resolved sooner.

Inform your staff

Communication is key when trying to reduce the number of Medicare claim denials that come back to your health care facility.

Staff members who submit claims must remain informed on changes in Medicare guidelines and rules. They must also have the training needed to properly submit claims.

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If your investigation into why denials are happening shows that staff members haven't been properly trained or informed on guidelines changes, make the necessary policy changes to correct the situation.

Don't let an uptick in Medicare claim denials affect your health care facility's revenue.

Instead, investigate the sources of the problems, take swift action to correct the troubles and set a new standard for keeping current with Medicare claim guidelines.

About the author: Shayla Ebsen is a freelance writer and editor with more than 10 years of professional writing experience both in the corporate and freelance settings

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Jun 8, 2021

Six issues at the top of tax and finance leaders’ agenda

Tax
Compliance
financeleaders
Deloitte
Kate Birch
4 min
As businesses accelerate their transformation journeys, tax leaders are under increasing pressure to add strategic value. Deloitte reveals six tax trends

New Deloitte research reveals that tax leaders are under increasing pressure to add strategic value as companies accelerate business model transformation, from undergoing digital transformations to rethinking their supply chains or investing in green initiatives.

According to Phil Mills, Deloitte Global Tax & Legal Leader, to “truly deliver value to the business, the tax function needs to rethink its resourcing model and transform its technology infrastructure to create capacity and control costs”.

And the good news, according to Mills, is that tax and business leaders have more options at their disposal to achieve this.

Reflecting the insights of global tax and finance executives at global companies, Deloitte’s Tax Operations in Focus study reveals the six issues at the top of tax and finance leaders’ agenda.

Trend 1: Businesses seek more strategic counsel from tax

Companies are being pushed to develop new digital products and distribution channels and accelerate sustainable transformation and this is taking them into uncharted tax territory. Tax leaders say their teams must have the resources and skills to give deeper advisory support on digital business models (65%), supply chain restructuring (49%) and sustainability (48%) over the next two years. This means redrawing the boundaries of what tax professionals focus on, and accelerating adoption of advanced technologies and lower-cost resourcing models to meet compliance requirements and free up time.

According to Joanne Walker, Group Tax Director, BT Group PLC, "There’s still a heavy compliance load today, but the vision for the future would be that much of that falls away, and tax people become subject matter experts who help program the machine, ensure quality control, and redirect their time to advisory activity.”

Trend 2: Tipping point for resourcing models

Business partnering demands in the tax department are on the rise, but 93% of tax leaders say their department’s budget is remaining flat or falling. To ensure that the tax function can redefine itself as a strategic function at the pace that is required, leaders are choosing to move increasing amounts of compliance and reporting to a combination of shared service centers, finance departments, and outsourcing providers that have invested in best-in-class technology.

Trend 3: Digital tax administration is moving faster than expected

in addition to the rising focus of the corporate tax department partnering with their business counterparts, transformative changes to the way companies share tax information with revenue authorities is also creating an imperative to modernize operations at a faster pace. Nine in 10 (92%) respondents say that shifting revenue authority demands on digital tax administration will have a moderate or high impact on tax operations and resources over the next five years—and several heads of tax said the trend is moving faster than expected.

"It’s really stepped up in the last couple of years," says Anna Elphick, VP Tax, Unilever. "Tax authorities don't just want a faster turnaround for compliance but access into a company’s systems. It's not unreasonable to think that in a much shorter time than we expect, compliance will be about companies reviewing a return that's been drafted by the tax authorities."

Trend 4: Data simplification and lower-cost resourcing are top priorities

Tax leaders said that simplifying data management (53%) and moving to lower-cost resourcing models (51%) must be prioritized if tax is to become more proactive at delivering strategic insights to the business. Many tax teams are ensuring that they have a seat at the table as ERP systems are overhauled, which is paying dividends: 56% of those that have introduced NextGen ERP systems are now highly effective at supporting the business with scenario-modeling insights. Only 35% of those with moderate to low use of NextGen ERP systems said the same.

At Stryker, “we automated the source P&L process for transfer pricing which took a huge burden off of the divisions," says David Furgason, Vice President Tax. "Then we created a transfer price database to deposit and retrieve data so we have limited impact on the divisions. We are moving to a single ERP platform which will help us make take the next step with robotics.”

Trend 5: Skillsets are shifting

Embedding a new data infrastructure and redesigning processes are critical for the future tax vision. Tax leaders are aligned — data skills (45%) and technology process experience (43%) are ‘must have’ skills in a tax department of the future, but more traditional tax specialist knowledge also remains key (40%). The trick to success will be in tax leaders facilitating the way these professionals, with their different backgrounds, can work together collectively to unlock lasting value.

Take Infineon Technologies, which formed a VAT technology and governance group "that has the right knowledge about how to change the system to ensure it generates the right reports", according to Matthias Schubert, Global Head of Tax. "Involving them early was key as we took a greenfield approach, so we could think about what the optimal processes would look like and how more intelligent systems could make an impact 

Trend 6: 2020 brought productivity improvements

Improved productivity (50%) and accelerating shifts to remote working (48%) were cited as the biggest operational benefits to emerge from COVID-19-driven disruption. But, as 78% of leaders now plan to embed either hybrid or fully remote models in the tax function long term, 34% say maintaining productivity benefits is a top concern. And, as leaders think about building their talent pipeline and strengthening advisory skill sets, 47% say they must prioritize new approaches to talent recognition and career development over the next two years, while 36% say new processes for involving tax in business strategy decisions must be established.

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