If you look up the top biller solutions for healthcare billing, you will find pages and pages of marketing materials, all of which promise the same thing using different fonts. Take those aside for now. The places that do an excellent job in collections don’t have the best software. It’s the places where someone spent some time analyzing what is being paid for and what isn’t and then reorganized the process based on that analysis. The following are the five behaviors that set those places apart.
Inconsistent billing is hard to notice. No one realizes on the day that the place of service code for the claim was incorrect. No one realizes on the day that an account is 97 days old. The money is lost silently, in small amounts and by the time it’s noticed, a soft month is created.
1. Set Deadlines
Most facilities track denial rate. Fewer organizations consider how many of those denials actually get worked, and it is the second figure which will determine whether your bottom line improves.
The denial in and of itself can always be resolved. The one left unworked for three weeks is not recoverable, because payer deadlines have no idea whether you were shorthanded during that period. Far too many organizations discover this truth through personal experience: a pile of remittances is left behind because of a heavy workload, and when they come back to them, the deadline has passed for half of them.
There is nothing glamorous about the solution to this problem. Denials require a champion, a queue, and a timeline. Someone must be accountable for the simple fact that a claim denied on a Tuesday will be worked on by Friday.
2. Re-verify Insurance Regularly Before Submission
Most offices verify coverage at admission and presume everything to be set and dry. They’re not. Coverage changes in January, when employer coverage stops for a job change. There’s redetermination of Medicaid coverage, and no one ever tells the provider about it.
The secondary insurance is the area of high expenses here. The primary is always verified since nothing will happen without it. However, secondary remains as it was entered the last time in a chart, even if this happened a year ago, and no one ever looks at it anymore. In skilled nursing, secondary coverage has already been stopped by the payer for months. You send the claim out, receive a denial and move the balance to the patient, who never knew why he is charged and most likely won’t pay anything. This balance will become a write-off, although the payer had been there all the while willing to pay.
The re-verification done before billing prevents most of these situations. It takes a few minutes for each patient. In terms of what the write-off will cost, the math is simple.
3. Document Procedures with Attention
Undercoding sounds safe. The doctor bills for a difficult visit, the coder selects the conservative level, everything is fine except for the practice losing revenue that it earned. And when it repeats several thousand times a year, it becomes an actual loss of money, which does not attract attention.
Overcoding is a more audible error with its audits and reimbursement returns. Neither of them is what we want. We need coding according to care rendered and documentation according to it.
And that is the problem where most practices are trapped, as the solution is not within the scope of billing. If a physician keeps making notes that do not cover the level of care he provides, there is no way the coder can save the situation.
4. Work Old Accounts by What’s Recoverable
The aging report is the most frequently generated and the least often utilized tool in the business. Everybody generates it, but fewer people process it, and hardly anybody processes it in the proper sequence.
The temptation is to start working the largest accounts. The recoverable type is the better category. A $400 balance with a correctable coding problem and only two months left in its filing period is worth your Tuesdays more than a $6,000 account which was appealed twice and denied twice.
Also, it makes sense viewing denial codes as useful information. If the same payer denies the same code forty times, it’s one single problem, and somebody must find it.
5. Talk to Patients in Advance
Deductibles have moved a significant amount of money from insurance companies to individuals, and individual payments are far more difficult to collect. Tightening the screws on collection doesn’t work, and it loses your good will, which you cannot buy back.
Early communication does work. Make your client aware of what will occur during their visit before visiting and give them something written that can be easily comprehended.
Ask Questions if You Outsource
Outsourced billing earned its reputation for good and bad reasons. Way too often, an agreement becomes a closed box where claims are sent out, money is received, but the practice remains clueless as to what was billed, denied or ignored due to the hassle factor involved.
Start asking questions before signing on any dotted lines. May I view claim status anytime I wish? What is your denial rate, and how are denials reported? Who is handling the appeals, and how quickly are they processed? Who helps the patient who called with a question about a bill? The percentage-of-collections arrangement works well and is generally aligned with everyone’s interest (provided that the scope of services is clearly spelled out in the agreement).
Key Takeways
None of this means inventing things anew. Get multiple coverage check points. Program and document your work. Work old accounts based on what is available. Assign ownership for denials. Speak to the patient before billing them.
The office that practices these things not only collects more but they collect sooner, have less arguments, and write off less money than what wasn’t lost in the first place.
