Presented by: Yvonne Dailey, CPC, CPC-I ALL RIGHTS REVERED

Transcription

1 Presented by: Yvonne Dailey, CPC, CPC-I ALL RIGHTS REVERED 1 Disclaimer The material are offered as tools to assist the participants in understanding their revenue cycle. No part of the presentation may be reproduced or transmitted in any form or by any means (graphically, electronically or mechanically, including photocopying, recording or taping) without the expressed written permission of Dailey Billing Services Inc. All Rights Reserved 2 1

2 Introduction Provider Practice as a BUSINESS Communication is Key Start of the Revenue Cycle Everyone has a Role and Responsibility Denial Management Timely Filing Guidelines and Corrective Claims Guidelines Getting the Patient involved Early Using New Technology Offer Multiple Payment Options Using the Internet for Skip Trace Techniques Performing Written as Well as Oral Communication Small Claims vs. Collections Agency All Rights Reserved 3 Keeping The Pulse Alive The practice is a Business Start off on the right foot Financial Policy Stick to it Set the rule on getting paid Set up collection goals weekly, monthly, quarterly, annually Know your surroundings Get patients involved early Offer different methods for payments Know when to cut your loses Know who you are contracted with VERY important when scheduling 4 2

3 Medical Billing Process 5 What is YOUR Role in this Process? Role Receptionist/Scheduler Provider Medical Coder Responsibilities Scheduels the paients appointment, Greets the patient, Verifies insurance & Eligiblilty Discusses inaurance coverage with the patient. Examines the patients Documents the patient s condition and treatment plan in medical record Interprets the medical record based on the documentation depending on facility they may add modifiers and procedures 6 3

4 What is YOUR Role in this Process? Role Charge Entry Clerk / Biller Payment Clerk Account Representive Responsibilities Verifies the case information for accuracy for claim submission Submits claims Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS Researches all denial/rejections, processes all corrections, resolves insurance billing or payment problems and establishes payment plan with patient 7 What is YOUR Role in this Process? Administrator Role Responsibilities Generates and reviews reports for supporting the billing process. These reports included daily, weekly, monthly, quarterly and yearly tasks. 8 4

5 Medical Billing Process Insurance Verification The first step First contact with patient Cycle starts The MOST important step in process Most Ignored Provider Network Inform Patient Upfront New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorization/precertification and/or referral are needed ABN The Referring Provider What Questions to Ask? 9 Medical Billing Process Insurance Verification Process Questions to ask Does the patient have a deductible? Has it been met? Does the patient have Co-Insurance? What s the percentage? Does the patient have a Co-Pay? How much is it? Start date and End date of coverage 10 5

6 Medical Billing Process Insurance Verification Name the Following Carriers: 1. W U NJX3HZN MEDBBDXE 5. MA A 7. YLM QFT Medical Billing Process Patient Demographics Review intake form to ensure the information is accurate Did the patient sign the financial Policy Make a copy of the insurance card front and back Make a copy of patient ID front and back Are ALL forms signed and dated Collect Copay, deductible, and/or co-insurance Update intake forms annually Start and End dates for insurance carriers REQUIRE IT Review your returned mail Review at each visit review ID also for changes 12 6

7 Medical Billing Process CPT & ICD 9 CODING The coder s responsibility is to review for accuracy Make sure not to leave money on the table Medical billing and coding is like a puzzle all piece must link together accordingly Medical Necessity Know your carrier guidelines and policies 13 Medical Billing Process CPT & ICD 9 CODING Let s review the following examples: Provider documented : Flu shot The flu vaccine can be billed a number of ways: Medicare (depending on your Medicare Carrier) Q0236 Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 Administration of Flu Vaccine To bill a commercial carrier: Flu Vaccine Administration of vaccine Changes if it was the FluMist This is a small sampling as there are multiple vaccines codes for the flu 14 7

8 Medical Billing Process CPT & ICD 9 CODING 15 Medical Billing Process Charge Entry Enter all charges Review BEFORE submission Based on the providers documentation Review for loss revenue ( administration, supplies, etc) Samples of things to review : NPI, referring provider information, on set date, DOB, DOS Know payer policies for what is billed Know carrier timely guidelines Are any modifiers needed 16 8

9 Medical Billing Process Charge Entry Let s review the sample charge ticket: How many billable charges are there? Is there anything missing? Will it require a modifier? Do you need a referring and/or ordering provider? Does it make a difference if this is a Medicare pt or a Commercial pt? Why or why not? Now let s look at the 1500 for this claim 17 Medical Billing Process Charge Entry 18 9

10 Medical Billing Process Charge Entry 19 Medical Billing Process Claim Submission Review and document your claim submissions If your clearinghouse allows corrections on the site, be sure to correct on your end also Review your EDI reports daily Know what reports are needed for appeals and/or fighting your timely filing Know your claim submission file # (837, 835, 997, etc) 20 10

11 Medical Billing Process Payment Posting All payments must be posted EVEN your ZERO dollar EOBs, even if you are going to work the denial/rejection, post it Know your denial codes such as CO50, CO45, PR204, etc Use notes in your system important Document all communication with carriers date, time and person you spoke to 21 Medical Billing Process Payment Posting Let s review the following example: Par Dr. Amt. Billed Pd at TOS Carrier payment Write off amount Amt to bill pt Differe nce $200 $10 $100 Non Par $200 $10 $

12 Medical Billing Process A/R Follow UP Follow Up - Most important to manage the A/R Must be able to research and know where to search Insurance Aging Patient Aging Work weekly, monthly, quarterly, yearly Pick up the phone it still works Document your follow up attempts, notes, letters, phone calls, etc. 23 Medical Billing Process Denial Management In many cases practice denials represent internal errors Loss of revenue or delayed revenue Track denials Train staff on payer policies, coding, billing, (your findings) Monitor Make staff members accountable 24 12

13 Medical Billing Process Denial Management Know the difference between a denial and rejection Let s review denial code: CO50 PR27 Which is a rejection and which is a denial? Understand how to read your EOBs Just because the EOB states to write it off, doesn t always mean you write it off APPEAL APPEAL APPEAL 25 Medical Billing Process Denial Management Clearinghouse Dashboards Gives complete summary (accepted /denials) Overview of your top rejections Use as training tool Share your findings with staff and providers Inform provider, not everything gets paid 26 13

14 Medical Billing Process Denial Management 27 Medical Billing Process Denial Management 28 14

15 Medical Billing Process Cost For NOT Working Denials 90 CLAIMS PER DAY AT $90 PER CLAIM = $8,100 IF 10% DENIED = $810 IN DENIAL PER DAY IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$ PER DAY 52 WEEKS X 5 DAYS 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS, 240 DAYS X $ = $174,960 LOST PER YEAR 29 Practice Analysis Medical Billing Process Useful Reports Insurance Aging (90, 120, 151) Secondary Aging (Medigap claims) Procedure Analysis Diagnosis Analysis Patient Aging Denial Report Surgery Report 30 15

16 Timely Filing Guidelines Carrier Time Frame United Health Care 90 Days from date of service Oxford 90 Days from Date of Service Aetna 180 Days from Date of Service Cigna 90 Days from Date of Service Cigna Great West 15 months Medicare 12 months (Calendar ) This will differ if the provider is NON PAR. For example Cigna is 180 Days 31 Proof of Timely Filing Most carriers want your EDI reports to show claims accepted and acknowledged by Payor Some Carriers REQUIRE you use their forms to appeal It s not enough to have an acceptance from your clearinghouse. They want acknowledgement that THEY received it. If you mailed your claims, then you should have mailed certified with return receipt

17 Corrective Claims Guidelines Carrier United Health Care Oxford Aetna Cigna Time Frame 60 Days from date of remit 60 Days from date of remit 12 months from date of remit 180 Days from date of remit Some may require that you use THEIR forms, other may allow you to simply write a request. Forms may vary depending on State where provider is located. Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT. Keep a file and/or log so you can track 33 Reasons Patients DON T Pay Job loss reduced income Emergency situations Loss of Insurance coverage Hardship Not understanding insurance plans Wasn t aware they owed 34 17

18 Killing The Awkward Silence Of Collecting Money Kill it with kindness Keep it simple, keep it professional, be assertive Offer multiple payment options 35 Different Type of Collections Letters Financial Policy Funds Were Paid To Patient Past Due Notices (30, 60, 90) Offering Different Payment Methods No Payment Received By Carriers Pre-existing Clause Insurance Verification Letter Financial Hardship 36 18

19 The Cost To Collect A Copay Copay Amount Cash/Check At time of service Credit card payment in office Billing the patient Billing the patient TWICE $20.00 $0 ($20.00) $.96 ($19.04) $3.00 (17.00) $6.00 (14.00) Patient has been billed three times and NEVER Pays - $ Different Payment Options Debit Cards Credit Cards Online AUTOMATIC withdrawals from checking or savings Check Cash Via your website Paypal 38 19

20 Online Bill Payment Merchant account now offer ways to pay by credit card via the internet where the patient feels comfortable putting in their own information. For example we use Netdeposit. Set up direct payment out of their check, saving and or credit card. Taken out automatically on a monthly or bimonthly ( check payment online) 39 The Benefits Of Online Bill Payments Automatic Debit from any account type Recurring Payment Schedules View Payment History View Future Payments Archived Payment Receipts Receipts ed to both Patient and Practice Payment Scheduled is also ed to Patient and Practice 40 20

21 Online Payment History GENERAL TRANSACTION VIEW BEGINNING 02/04/2013 Month Checks Chk Amt Credit Cards Credit Amt Total Rev Feb $ $ $ Mar $ $ $ Apr $ $ $ May $ $0.00 $ Jun $ $0.00 $ Jul $ $0.00 $0.00 Aug $ $0.00 $0.00 Sep $ $0.00 $0.00 Oct $ $0.00 $0.00 Nov $ $0.00 $0.00 Dec $ $0.00 $0.00 Jan $ $0.00 $0.00 Feb $ $0.00 $0.00 TOTALS: 5 $ $ $1, Skip Tracing Methods What is Skip Trace? Skip Trace Identifiers: Patient s EXACT full name Date of Birth or Age Social Security Numbers Previous Address Last Known Driver s License Number Insurance Policy Numbers 42 21

22 Skip Tracing Methods- Let Your Monthly Statements Do the work For YOU Use your Postal Service - Ancillary Service Endorsements Return Service Requested Temp-Return Service Requested Address Service Requested Change Service Requested NCOA-Link services 43 Letting Monthly Statements Do The Work For YOU 44 22

23 NCOA-LINK 45 Internet Skip Trace Many different websites to assist you Other people search sites The cost vary from $1.00 to $

24 Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States. Click on the View Details or Get a Detailed Report link for more info. = Available Search Again >> See Details on All 8 People! Name Yvonne D Dailey Yvonne D Dailey Age Yvonne D Dailey 52 Previous Cities Bradenton, FL Oneco, FL Long Branch, NJ Albuquerque, NM Toms River, NJ Austin, TX Claremore, OK Spicewood, TX DOB Phone Address Avg. Income Avg. Home Value Relatives Randall T Dailey (40) Connie Y Dailey (70) Thomas M Dailey (70) Constance Y Dailey (70) William F Dailey (36) Delroy A Dailey (40) Bill Dailey Mr Dailey Camille Yvonne Dailey (52) 47 Jon Dailey Perform written as well as oral communications Use the collection letters Call the patient if over 60 days Offer a payment plan and stick to it Never complete your collection conversation without collecting a least a third of your outstanding balance if you can t collect the full balance and be sure to have a payment plan in place 48 24

25 Small Claims vs. Collection Agency Know when to cut your losses and at what price Regardless of route you used, you will need to prove your collection efforts Small claims will cost you the cost of court plus the attorney fee Patients fear court Collection Agency negotiate your fees (28 to 45% of collections) 49 Questions? Thank you for attending. How to contact us: Yvonne Dailey, CPC,CPCI Website:

26 Resources United States Postal Service Netdeposit Online Merchant Vendor Useful websites: Example letters: Yvonne Dailey-Dailey Billing Services