Showing posts with label Medical Billing & Collections. Show all posts
Showing posts with label Medical Billing & Collections. Show all posts

Monday, January 6, 2020

Collecting effectively without undermining patient relationships

Could collecting from patients be the modern medical practice’s least favorite administrative task? Based on my experience, I’d say it’s certainly a candidate.


It’s a hard task to like, mainly because it’s a hard task to get right. Bungling it may mean that your practice never gets paid for some services it provides, but being too aggressive may inadvertently convey that your practice is more concerned about money than patient care.

Throw in high-deductible plans that have made patients responsible for more of the cost of their care, and it’s easy to see why patient receivables have become such a challenge to profitability for hospitals systems, small independent practices, and every type of healthcare organization in between.

There’s no instant, painless cure-all for patient collection problems, but there is good news. It may seem counterintuitive, but collecting well doesn’t have to be at odds with patient service. In fact, taking the right steps to collect better can actually help you forge better patient relationships.

Knowledge is power


Surprise medical bills cause ill will that can undermine physicians’ relationships with their patients. In many cases, though, the “surprise” is caused mainly by patients’ misunderstanding of health plan rules.

Educating patients about their insurance may not seem like your job. Insurance companies and employers should help patients understand the complicated terms of their insurance. But whether because patients ignore insurance information until they need treatment, insurance is very complicated, or insurance companies don’t try hard enough (or all of the above), the task of explaining insurance will frequently fall on your practice’s plate.

It’s tempting to wait and see if a patient misunderstands before jumping in to explain payment terms, but it’s better to be proactive—if you wait until a patient is confused by a bill, expensive damage may already be done. The patient who receives an unexpected bill may assume it’s wrong, refuse to pay, and even become angry. Your ability to collect what you’re owed will diminish—along with the patient’s trust in your practice. If you help your patients better understand their insurance, they’ll have an easier time navigating all of their healthcare transactions, and they’ll have you to thank for it.

Head off confusion with education—starting when the patient sets the appointment. Make sure your practice management system is able to provide your schedulers with accurate patient payment responsibility data, and your schedulers are trained to confidently access and explain this information.

Arm front-desk staff with training


The time of service is a critical time both for reinforcing payment terms and collecting. Starting the education process at the time of scheduling will make front desk collections much easier, because patients better understand their payment responsibility. But it will still be less effective than it should be if front desk employees feel unprepared for the task.

Develop a clear, consistent process for collecting from patients at the front desk. Make sure your employees have a straightforward, standard way of asking for payment (“i.e. How would you like to pay your copay today, Ms. Andrews?”). And make sure the way they ask for payment neither sounds apologetic nor implies that payment is optional.

Offer role-playing practice and refresher training for your employees from time to time. And recognize that, occasionally, a trustworthy and valuable employee may be too introverted to ever feel fully confident in this role—consider preferences and personalities when (re)designing staff roles in your practice.


Make sure the rest of your billing process is optimized


The likelihood that patients will feel surprised by bills they didn’t expect is also tied to timing. If it’s been several months since they received services and they’ve not been billed by your practice or even received an EOB from their health plan, patients are more likely to conclude they don’t owe anything. That sets the stage for more frustration when a bill arrives later.

Making sure your insurance billing processes are as efficient as possible can reduce this risk. If you’re submitting claims as cleanly and quickly as possible, you’ll minimize the time it takes your patients to receive EOBs from their insurance (and, of course, you’ll also get your insurance payments faster).

Virtually every aspect of the billing process is connected. Improvements in one part of the process may spill over and improve other parts, too.

Technology can help drive these improvements. Most practice management systems have rolled out automations and other tools to reduce errors and make the routine aspects of billing easier. If you haven’t had recent training on all your systems can do, consider setting up a session with your vendor.


Online bill payment has evolved in recent years from a nicety to an essential. If you’re the only creditor expecting your patients to find a stamp, write a check, or call during a busy workday, you’re significantly adding to the pain of paying your bill. Make it easy for patients to pay you! Even if your practice management system lacks a built-in solution for self-serve patient bill payment, third party systems are available that integrate with many systems. Be sure to ask your practice management system vendor about these options, too.

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Wednesday, September 4, 2019

How to avoid these 5 common nedical billing mistakes

It’s easy to make small mistakes when billing. Unfortunately, small mistakes can sometimes cost you big money. Fortunately, it might not be as difficult as you think to avoid them. Here are five ways to prevent some of the most common — and costly — billing mistakes.


Use the right modifiers


By now, everyone is accustomed to ICD-10. Or mostly accustomed. But modifiers can still be tricky. Not using modifiers can, of course, cause a claim to be denied. But so can using the wrong one.

Not using the right modifier is one of the most common billing errors, says Karen Lake, healthcare consultant with Pearce, Bevill, Leesburg, Moore.

Making sure your staff is well-trained is key to avoiding this mistake. Don't waste time training and retraining staff on codes that you're practice doesn't use. Instead, be sure training focuses on any diagnoses and procedures your practice uses often.

Bill the right payer


This may sound like a no-brainer, but it’s actually an easy mistake to make. Lake offers a good example of how this can happen. Say a patient comes in and gives you his Medicare card. The front desk carefully records the information, and billing submits the charge to Medicare. But the claim is rejected, maybe even from the clearinghouse.

The problem? The patient thinks he’s on Medicare, but his policy is actually with Blue Cross, United Health Care or another Medicare Advantage plan. The easiest way to avoid this kind of mistake is to always verify insurance at check-in.

Sweat the small stuff


Leaving off even one of the required fields in a bill can result in a denial. It’s easy to double-check to make sure you've provided all the required information before submitting the claim. What’s trickier is making sure all the data in those fields is correct. It’s easy to misspell a name or transpose numbers, especially during busy times at the front desk.

Despite the hectic pace, it’s worth taking the time to slow down and get this right. Then taking a little more time to double check. Kenneth Hertz, FACMPE, principle consultant at MGMA Health Care Consulting Group, suggests having a separate space for taking insurance information, if possible. A separate room is ideal, but if you don't have the space for that, at least try to arrange for a cubicle or quiet corner to keep distractions to a minimum during this detail-oriented process.

Run an analysis


If you’re really serious about reducing billing errors, it’s worth the time to analyze your mistakes. EHR systems allow you to customize reports, says Brennan Cantrell, commercial health insurance strategist for AAFP. "I like to look at high-dollar claims first," he says, to get the most return on his investment of time.

Whatever approach you take, make sure you look for any patterns in your mistakes. Are you making a lot of coding errors? Are those coming from billing or from clinical? Spotting your most frequent mistakes can help you set your training priorities.

Explain your decisions


Not getting prior authorizations when payers require them for procedures and medications is another common mistake. They’re also a hassle. “Pre-authorizations are a big administrative burden. It’s one of the biggest issues for our members,” Cantrell says. “If you have enough staff, it’s ideal have one person in charge of this.” If that’s not possible, you may need to consider reviewing and adjusting workloads.

You also need to make sure the diagnosis code and the procedure code match in order to demonstrate medical necessity to payers. If not, the claim will be refused. It’s important that your staff be well trained on coding if you want to avoid this common error. This applies to clinical staff as well as billing staff. " It’s a good idea if the billing department does in-service training so that the clinical staff has a better idea of how to code complicated cases," Lake advises. "They don’t need to know all the details, but they do need to know when to call in the billing department for clarification."

Mistakes happen. But if you learn from those mistakes, you can avoid making them in the future — and save money while improving your practice.

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Wednesday, August 14, 2019

5 questions to ask about wRVU compensation

Physicians employed by a medical group, hospital or academic institution are commonly compensated using a productivity formula based on work relative value units (wRVUs). Since wRVUs drive your paycheck, it’s to your advantage to ask questions in order to understand how the system works — and specifically how your employer counts wRVUs.



What are wRVUs?


Medicare establishes an RVU for each CPT code to determine reimbursement. The RVU has three components: physician work, practice expense and malpractice. The physician work RVU, or wRVU, is a "neutralized" way to quantify and compare the productivity of physicians because it eliminates variables such as fee schedules or geographical costs.

Most groups multiply the wRVUs for services provided by a conversion factor to determine all or part of a physician’s compensation. For example, a surgeon who is paid at $60.00 per wRVU and produces 6,000 wRVUs would be compensated $360,000.



What’s there to understand?


It seems pretty simple, but as the saying goes, the devil is in the details. Counting wRVUs is not entirely straightforward, and too often a lack of transparency between administrators and physicians, whether intentional or not, sows seeds of doubt that can grow into a tree of distrust and hostility.


5 questions to ask your administrator


To avoid this dismal destiny, ask your administrator these five questions to start the conversation of understanding how the system works. (Administrators, be sure you can answer the questions. Better yet, consider proactively discussing your institution’s wRVU methodology with employed physicians to keep communication lines open and clear.)


1. Are wRVUs credited on codes submitted or codes paid?


In most cases, you will be credited for the CPT codes submitted, regardless of the reimbursement received. But get clarification about that, anyway. Furthermore, understand if reports are generated using date of service or the date the charge was billed out. This will make a difference for those services performed in one month that are billed out the following month. Remember: Delays in billing, whether by you or by the billing team, can delay wRVU credit for your compensation.



2. Do modifiers impact the wRVU credit? If so, how?


Modifier impacts to wRVUs commonly cause physicians to believe they’ve been “cheated” out of compensation earned.

Some groups discount the wRVU for the second side of bilateral procedures, consistent with the reimbursement methodology used by most payers. For example, the CPT code 19318 for a breast reduction surgery has 16.03 wRVUs. When billed as a bilateral procedure (by attaching modifier 50), many payers will reimburse for 150 percent of the fee schedule, not 200 percent. Likewise, the hospital will credit the surgeon with 24.0 wRVUs, not 32.06. Physicians who discover this type of wRVU adjustment months or years into their employment are typically shocked at the perceived deception.

Other modifiers that may decrease wRVUs are:
  • modifier 51 - multiple procedure
  • modifier 59 - distinct procedural service
  • modifier 62 - two surgeons/co-surgeons
  • modifier 76 - repeat procedure
  • modifiers 80 - assistant surgeon
  • modifier 82 - assistant surgeon when a qualified resident surgeon is not available

3. What credit do I receive if I bill a code for an unlisted procedure?


CPT codes for unlisted procedures, such as 64999 (unlisted procedure, nervous system), are not assigned a wRVU by CMS. If you use any of the unlisted codes, have a discussion with your administrator about a suitable value for the service. Suggest a similar procedure to use as reference and discuss an appropriate adjustment to the wRVU to reflect the work required for the unlisted procedure.



4. Who is authorized to change the codes/modifiers I submitted?


Best practice is for physicians to assign the CPT codes for services performed. In most cases, after you submit your codes, a coder or biller reviews the charges and potentially changes the code(s) or modifier(s) based on documentation and payer rules. This directly impacts physician compensation, so you should take interest in who is handling your claims.

Understand the protocol for making changes and insist on a system for being notified. And, ensure that you, as well as the coders and billers, stay current on coding education.


5. Can I see a detailed transaction report each month of the codes submitted and wRVUs credited?


Shrewd physicians insist on reviewing the transaction report each month to ensure all services were billed and to confirm the correct wRVUs were credited for each code. Consider keeping your own log of codes submitted and reconciling it with the monthly report to confirm all services were captured. Doing this monthly is a good habit, allowing you to catch discrepancies early so they can be quickly addressed.

To ensure you are paid for the work you do, it’s essential for physicians to be actively involved with reviewing wRVU calculations. Likewise, it’s important to have open and ongoing communication between physicians and administrators to maintain an accurate compensation plan as well as high physician engagement.

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