SIX AND A HALF STEPS FOR JANUARY

1.  Verify Patient Information – Some patients may have changes to their insurance plans.  Even if they are keeping the same insurance company, they may have changes to the underlying benefits.  It is critical to obtain a copy of the new card and re-verify benefits.

2. Authorize and Re-authorize Services – If the patient presents with a new card with a different payer, it is imperative to authorize upcoming services with the new payer.  The one denial that is almost impossible to overturn is No Authorization.  Be sure that secondary procedures are authorized prior to performing them.  Be sure to also pay attention to the ‘window’ of time that the authorizations have.

3.  Conservative Therapy Changes – If the patient’s new card has a different – read more restrictive here – conservative therapy program, the new program’s processes must be met.  For example, Patient Able has JoeBob Insurance with a six week conservative therapy program and they change to a Blues plan with a three month conservative therapy window.  The three month conservative therapy program must be met before moving forward with treatment. Any therapy is welcome, but not just any therapy to start a good and successful new year, body sculpting Scottsdale will prepare you in body, soul and mind whatever the new year is, even every day you will live it as if it were unique, forget about the gray cycles of life.

4.  Deductibles – Unfortunately the payers have made you become the bank when patients seek care.  It is critical to have a plan in place in dealing with patient’s deductibles.  The front staff or check out person must understand the plan and be able to implement it.  Assure your team that this is necessary and not mean.  That you are doing the patient a service by reviewing what may be owed and implementing a plan rather than surprising the patient three months later.

5.  Coding – Whether you are using an integrated Electronic Health Record/Practice Management software system or using superbills, your biller cannot submit the claim without the necessary CPT codes and ICD-10 diagnoses.  Strive to ensure these are submitted the same day or the next day to your biller.

6.  Charting – Likewise, many payers require a copy of the operative report before they will pay the claim.  Delays in creating these reports will create delays in your payment process and unnecessarily increase your Accounts Receivables (making it harder to work also!).  Try to re-commit some time to keeping your documentation current.

6.5 Professional Services – Many organizations now focus on ‘core competencies’.  Billing and claims follow up are not typically a core competency for a practice.  If you are experiencing significant delays in reimbursement, consider hiring a professional billing company to support you.