Practice managers and physician-owners have so many things of which to keep track. Trying to ensure your internal biller or external billing company is doing some of the right things is just another added burden. Below are a few quick items that are easily reviewed and can give you a bit of peace-of-mind.
With so many payers now accepting and sending information back electronically, many of the medical software and Specialty Medical Billing systems currently available can help improve your processes. In many cases if you do not work the “help” being given right away it can potentially make life difficult.
Clearinghouse Reports:
When submitting claims electronically your clearing house will send you multiple reports for multiple reasons. The most common one is “Claim Accepted,” or “Claim has been submitted.” This of course does not mean it will pay, but does mean that the claim has been sent by the clearing house to the insurance company.
However, the clearinghouse reports are more detailed in some cases, and are in need of reviewing on a regular basis as multiple commercial insurances have been known to communicate needing medical records, incorrect ID numbers, and missing information through “Rejected” clearinghouse reports.
There are multiple errors that might occur on any given day, it is software after all, and by working the reports daily you are less likely to run into major issues later on. As a manager, you may want to periodically review to see if these are being reviewed and marked as such.
Zero Pays:
No one likes not getting paid; however, it is a part of the industry we work in. With deductibles, coinsurances, medical documentation requests, and change in policy numbers there are so many reasons you might not get paid. However, you will still receive a notice through an explanation of benefits in most cases. It is always important to post these. There is a lot of information that is received with zero pays, and this includes deductibles and permission to bill the patient any money they may owe.
Multiple times we have seen “Zero Pays” not being posted as it looks like there is nothing to post. The denied EOB’s however will tell you if the insurance company needs medical records, or if it is missing an authorization number. While you might not be getting money right away, posting and leaving notes on these accounts will make it easier to resolve the reason for the zero pay later.
Notes:
If your biller gets sick and is out of the office for a week are you ready? Can you answer phone calls, and help the patients who having been arguing with their insurance for months? All too often we have started billing for a practice that has no notes. All the software we have used has had a place to put down information in regards to patient phone calls, and insurance discussions. Documenting patient conversations will make it easier in case anyone is out. It also creates a legal record should an account ever be placed with a collections company.
Put yourself in the mindset that you might not be the next person to speak with the patient or insurance company. Make it as easy on the patient, and yourself, as you can. No one has ever complained of having too many notes on a problem.
No comments yet.