2009 EXECUTIVE WAR COLLEGE MASTERS CLASS APRIL 28, 2009 SECRETS TO ACHIEVING A TOP PERFORMING LAB BILLING/COLLECTION EFFORT

Size: px

Start display at page:

Download "2009 EXECUTIVE WAR COLLEGE MASTERS CLASS APRIL 28, 2009 SECRETS TO ACHIEVING A TOP PERFORMING LAB BILLING/COLLECTION EFFORT"

Arthur Campbell
8 years ago
Views:

1 2009 EXECUTIVE WAR COLLEGE MASTERS CLASS APRIL 28, 2009 SECRETS TO ACHIEVING A TOP PERFORMING LAB BILLING/COLLECTION EFFORT 1

2 Questions: AGENDA -Do you know if you are you happy with the present billing situation? -Do you know if the billing operation is running well? -How can you determine if the present situation is running well? -What to do to achieve a top performing lab billing/collection effort. Agenda cont. The most important facts to remember are: Understanding the issues Measurability of the issues Communication of the issues Taking action on the issues Accountability of the issues Reporting progress on the issues 2

-What to do to achieve a top performing lab billing/collection effort. Agenda cont.

3 GUIDELINES FOR THE CLASS TODAY I would like this class to be interactive. I would appreciate questions and quick caveats from you that help others learn. Please note I am going to concentrate more on the procedures and reporting we use to ACHIEVE AN 88% or better clean claim ON THE FIRST SUMISSION. Guidelines cont. -To achieve the 88% clean claim percentage requires a combined commitment from the billing office and the lab itself. Without the other, it can t be achieved. 3

Please note I am going to concentrate more on the procedures and reporting we use to ACHIEVE AN 88% or better clean

4 ARE YOU HAPPY WITH THE PRESENT BILLING SITUATION This question applies whether you do the billing in house or outsource it. How many do the billing in house? How many are happy with the results? How many outsource the billing? How many are happy with the results? Do you know really know if the billing operation is running well? Yes No 4

How many are happy with the results? How many outsource the billing?

5 How can you determine if the billing operation is running well? How do you know that your Billing operation is running well? Common Sense Procedures Review all front end denials and edits Review all electronic claims denials and edits Review all ERA no payment denials Review all correspondence zero payment denials 5

Common Sense Procedures Review all front end denials and edits Review all

6 What to do to achieve a Top Performing Lab Billing/Collection Effort? Review Accounts Receivable Agings from date billed. Have staff explain the issues in the 90 day, 120 day and 150 day buckets by issue and number of accounts and dollar amount. Secrets Set up Financial class for all front end denials and edits Set up Financial class for all electronic payment denials and edits Set up Financial class for items returned to the lab for follow up 6

Have staff explain the issues in the 90 day, 120 day and 150 day buckets by issue and number of accounts and

7 Secrets cont. -Our system allows us to set parameters by client by financial class as to when the claim comes back to the staff to be worked. It also tracks whether it was worked or not. -You need to set up a realistic system that allows the proper time to follow up on an issue, but also tracks the accountability as to whether it was done. What to do to achieve a Top Performing Lab Billing/Collection Effort cont? The key here is to identify the issues, who is accountable, and the resolution date. This keeps the accountability right up front and the billing manager will know you expect an update next month. This way the issue is not forgotten. 7

-You need to set up a realistic system that allows the proper time to follow up on an issue, but also tracks the accountability as to whether it was done.

8 KEY ELEMENTS AGAIN The most important facts to remember are: Understanding the issues Measurability of the issues Communication of the issues Taking action on the issues Accountability of the issues Reporting progress on the issues How do we track the progress? -I am going to discuss some of the practical every day reports we use to achieve the clean claims and then some reports used after the fact to determine how the client is doing. 8

on the issues How do we track the progress?

9 3 Levels of Reporting Working reports-daily or weekly reports to work denials, issues, etc. Accounting Reports-monthly reports delineating the results. Analytical and Problem Solving Reports Working report-denial Reporting Denial Type Amount CPT/ICD-9 Coding Issues Total $ (31,494.00) Duplicate Denials Total $ (65,256.80) No Authorization Total $ (555.60) Globally Paid Transplant $ 2, Prof Comp Not paid by Carrier Total $ (320,259.45) Test Not on Medicaid Fee Sched Total $ (810.18) Timely Filing Total $ (1,745.00) Grand Total $ (417,510.03) 9

Analytical and Problem Solving Reports Working report-denial Reporting Denial Type Amount CPT/ICD-9 Coding Issues Total $ (31,494.

10 Denial Reporting Cont. Timely Filing Total 0.41% Test Not on Medicaid Fee Sched Total 0.19% CPT/ICD-9 Coding Issues Total 7.45% Denials Oct 2008 Duplicate Denials Total 15.44% Globally Paid Transplant 0.62% CPT/ICD-9 Coding Issues Total Duplicate Denials Total No Authorization Total Globally Paid Transplant Prof Comp Not paid by Carrier Total Test Not on Medicaid Fee Sched Total Timely Filing Total Prof Comp Not paid by Carrier Total 75.76% No Authorization Total 0.13% Accounting Reports -Charge, receipt and Adjustment MTD, YTD and yearly comparison by Location, referring physician, attending physician, by insurance carrier, etc. -A/R aging -CPT Frequency by referring Physician, etc -ETC. 10

62% CPT/ICD-9 Coding Issues Total Duplicate Denials Total No Authorization Total Globally Paid Transplant Prof Comp Not paid by Carrier Total Test Not on Medicaid Fee Sched

11 Analytical and problem solving reports These are just a few examples or reports used by our clients on a quarterly or semi annual basis. Activity by CPT for September 08 as of December 08 CPT Group Units Charges Receipts Adjustments Balance Avg Chg Avg Rec BLUE SHIELD 204 $14, $5, $8, $ $72.95 $25.99 HMO ILLINOIS 178 $12, $4, $8, $ $72.84 $25.83 INDEMNITY 26 $1, $1, $ $98.70 $72.64 $43.22 MANAGED CARE 232 $16, $6, $10, $ $72.88 $27.03 MEDICARE 6 $ $0.00 -$ $0.00 $63.75 $0.00 SELF PAY 16 $1, $ $ $ $73.00 $20.49 Total 662 $48, $17, $28, $1, $72.80 $26.62 G0123 MEDICARE 18 $1, $ $ $ $79.00 $16.97 G0123 Total 18 $1, $ $ $ $79.00 $

99 HMO ILLINOIS 178 $12,966.25 $4,597.30 -$8,003.95 $365.00 $72.84 $25.83 INDEMNITY 26 $1,888.75 $1,123.81 -$666.24 $98.70 $72.64 $43.22 MANAGED CARE 232 $16,908.25 $6,271.24 -$10,298.65 $338.36 $72.

12 Expected vs. Actual reimbursement from UHC CPT Desc Count Chg Expected Paid Difference PSA, TOTAL SCREENING , , , , DRAWING BLOOD , , , , BASIC METABOLIC PANEL , , , , ELECTROLYTE PANEL COMPREHENSIVE METABOLIC PANE , , , , LIPID PANEL , , , , RENAL FUNCTION PANEL 18 1, ACUTE HEPATITIS PANEL 42 13, , , Cost Data by Lab Test Code with Profitability This report can be done by client, by site, by client billing vs. third party billing by client, by insurance carrier etc. This report is a 3 level pivot table with over 25,000 records. It was not able to be displayed. 12

16 24,657.80 80061 LIPID PANEL 3671 256,970.00 51,540.84 29,725.94 21,814.90 80069 RENAL FUNCTION PANEL 18 1,620.00 163.76 55.13 108.63 80074 ACUTE HEPATITIS PANEL 42 13,860.00 2,096.01 1,677.64 418.

13 Questions I would be happy to answer any questions now. Thank you! Kevin J. Ellison President and CEO Kellison & Company 4925 Galaxy Parkway Suite U Cleveland, Ohio kellison@kellison.com 13

December 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.

December 2011 PRACTICE CHECK-UP XYZ Anesthesia Group AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.com (908)-279-8120 AdvantEdge Healthcare Solutions Anesthesia Practice Check-Up I. Introduction: