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Stop any Bleeding Early
by AJ Riviezzo
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As a billing and collections company, we get to see the end results of some rather interesting problems that a practice has had with either their old billing company or with their in house biller. Below are a few items that the practice manager or physician management may want to review to ensure that your accounts receivable are being managed in an appropriate fashion.
Review of Clearinghouse Reports – Quite frequently this very important report is not being reviewed or is not acted upon. When your electronic claims are sent, the clearinghouse typically sends a report back letting you know if the claim was received, if it was accepted by the payer, and if all is going well. If this report is not being worked, it could be weeks, months or possibly never before the claim is reviewed and action taken if there was a problem. Often the problem is something simple like a mis-keyed patient identification number and can be fixed rather rapidly IF the reports are being worked.
Billing Medicare Secondary Claims – Another electronic report that may not be reviewed appropriately is the Medicare Remittance Advice. Most Medicare patients have a supplemental insurance policy that pays the coinsurance and deductible amounts on behalf of the patient. Most of the time, Medicare automatically transmits their payment information to the secondary policy, using Insurance Claims Automation Solutions. Sometimes Medicare is unable to accomplish this transmission. If so, it is noted on the remittance advice. However, someone has to review the remittance advice and bill these secondary payers. As the process can be a bit cumbersome depending upon the software used, many billers ignore this issue as the dollars are relatively small. Of course, small dollars added up become large dollars.
Working Denied Claims – All physicians and practice managers understand there are timely filing requirements for submitting a claim. These vary by payer. What may come as a bit of a shock to some is that there are timely appeal windows as well. Many payers only allow ninety days for an appeal of a denial. Time is, therefore, of the essence. If a claim is denied, it cannot simply go to the back of the queue to be worked. It needs to be addressed in a very timely and conscientious way. Simply ‘re-billing’ the claim – to receive the same denial – is not an effective strategy for obtaining payment on the claim.
Working the Accounts Receivables – The hardest part of being a biller is that you are also the collector. This is especially true for in-house billers. There are competing demands for the biller’s time and many are pulled in a multitude of directions. This usually means that the last thing performed is a review and working of the accounts receivable (A/R). The A/R should be reviewed every thirty days. All claims over 60 days old (and ideally over 30 days old) should be called upon to ascertain status of the claim. Sometimes the answer is that the claim is in-processing. Other times the claim is pended for medical records. Or perhaps the claim is not on file. All of the calls should be documented in your billing or EHR system. If there are no notes or no consistent notes in the electronic system, this is a red flag. It is unlikely that your A/R is truly being worked. A note pad with some names and notes on it is not a system.
A relatively quick review of these four elements can help you be assured your money is being collected in a timely and prudent manner… or that you do indeed have a few items to worry about.
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