Medical Billing Tip of the Month–September

April Hoak, Billing Manager, AllDocuments, Inc. September 16th, 2010

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Updating a Pivot Table When Using Kareo Excel Add-In for Reports

When using Kareo Excel add-in for reports, if you have already created your pivot table and realize you need to make changes to your query, it’s very easy to update your pivot table. Simply make your changes to your query and click on Refresh Query. This updates your data table. Then go back to your pivot table:

  1. Click Options
  2. Click Change Data Source – this takes you back to the Charge Data worksheet
  3. Change Pivot Table Data Source box opens
  4. On the far right of the Table/Range field, click on the little box with the red arrow inside
  5. Select your entire Charge Data table
  6. Go back to the Move Pivot Table box and click on the little box with the down arrow on the far right
  7. When the pop up box changes back to Move Pivot Table, click OK
  8. Click Refresh under the Options menu
    You have now updated your Pivot Table.

April Hoak
Billing Manager
AllDocuments, Inc.
866-615-5226 x113

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Gear Up for Success: Strategies to Remain Positive in Today’s Healthcare Economy

Dave Jakielo, CHBME September 16th, 2010

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It seems you can’t pick up a newspaper or magazine or download an ezine that one of the top articles isn’t about healthcare. There is an overabundance of issues facing us in 2010 and beyond and we need to develop a strategy to ensure we continue on the pathway of success. Here are some key areas to address:

1.      Find Quality Staff

When I talk with managers across the nation, one of the biggest issues they convey to me is the challenge of recruiting and retaining quality staff members. You would think with a national unemployment rate in excess of 10 percent that it would not be hard to find excellent employees. But not everyone out there is qualified. It is imperative to make sure you invest time in the recruiting and interview process.

While there is no foolproof way to ensure you have made a smart hiring decision, here are two tools that can help your odds:

  • Administer a profile assessment (available on the web) to see if the person will fit into your practice culture.
  • If you are hiring for an accounts receivable position, test the applicant to determine his or her level of knowledge and if additional training will be required. Ten years of experience doesn’t ensure that someone knows what he or she is doing.

2.      Catch the Insurance Curve Ball

Every company must also be prepared for what the insurance companies are throwing at us to try to hinder the claims adjudication process. Some examples are:

  • Additional services requiring pre-authorization
  • The growth in non-covered services
  • Possibility of bundling payments back in with the hospital’s payment
  • “Non-negotiable” insurance payments
  • The never-ending quest for additional documentation

Given these trends it’s important to make sure you have a sound self-pay collection policy and professionals working in your accounts receivable department. Your self-pay policies should include collecting co-pays and deductibles the day that services are rendered. If the patient cannot pay their deductible in full at time of service, have them pay half and bill them for the other half within 20 days. Keep in mind that today we must work with the insurers rather than against them because they are the ones controlling our clients’ reimbursement.

3.      Beware the Recovery Audit Contractors

If Paul Revere were still here, he’d probably saddle up his horse and gallop through the street shouting the “RACs are coming! The RACs are coming!” Yes, the recovery audit contractors are revving up for an all-out attack on the “evil practitioners” who are miscoding, over-utilizing, and just downright abusing the Medicare system. Be warned and remember a RAC contractor will NEVER show up at your office; they are auditors, not enforcers. Audits are not done on site, just via the mail.

4.      Take Positive Steps

If the above has totally depressed you, don’t fret; all is not lost. As we’ve said before, challenges create a plethora of opportunities. We know that the healthcare delivery system will not become less complex— just different— so don’t put your head in the sand and hope that this too shall pass. Force yourself to maintain a positive mental attitude. Positive people live in the future and are solution-oriented; pessimistic people live in the past and make excuses.

Here are some hints that can help you acquire and maintain a positive attitude:

  • Become a continuous learner. Load your iPod with educational materials and listen while driving or exercising. You should invest about three percent of your net income annually into your personal development. It’s amazing how acquiring knowledge in relation to a subject reduces your apprehension about it.
  • Block your calendar for “Thinking Time.” Yes, make an appointment to spend time just thinking. Write a problem on the top of a blank sheet of paper and as solutions come to mind write them down. To make this exercise effective you should spend your thinking time in one of your favorite places. Mine is on a Saturday morning with a pot of coffee before anyone else in the house is out of bed.
  • Lastly, avoid “Crackberry” disease. There is no written rule that states that we have to be connected to one another 24 hours a day, 7 days a week. It’s OK to turn off your phone, portable email, and texting device and spend time on other priorities, such as your family.

We know that the healthcare environment will be ever-evolving; it must, because the Medicare rolls will increase by nearly 50 percent in the next 15 years and things can’t remain status quo. So you have three choices regarding your future: 1) you can make things happen, 2) you can watch things happen, or 3) you can sit back and wonder what happened.

The choice is yours.

Dave Jakielo, CHBME, is an International Speaker, Consultant, Executive Coach, and Author, and is president of Seminars & Consulting. Dave is past president of the Healthcare Billing and Management Association and the National Speakers Association Pittsburgh Chapter. Sign up for his FREE weekly Success Tips at www.Davespeaks.com. Dave can be reached via email Dave@Davespeaks.com; phone 412-921-0976.

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Improving Billing Productivity: Automation and Processes

Liz Jones, MS, CMBSI September 16th, 2010

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At the Medical Association of Billers, we hear some of the most amazing comments.  Did you know there are still offices that don’t use practice management software?  They use the free Adobe CMS 1500 plug in claim form on the Internet to process their claims. The reason is because the physician does not want to “invest” in the software.  In our opinion, wasted time means lost money.  As we all know, claim forms must be “clean” (without errors) so a single typing error would necessitate the typing of the entire claim form again.  And what happens when the claim comes back from the carrier?  Billers tell us that they enter the information into an Excel spreadsheet!  Practice management software can make routine accounting and billing easier and more efficient.

Take Advantage of Your Practice Management Software

I know most, hopefully all, of you are using practice management software to generate your claims, but are you taking advantage of all the benefits available to you?  Here are few suggestions for making your office more efficient and productive:

  1. Process your claims electronically.  It is generally accepted that electronic claims save between 7-14 business days over paper claims. With paper claims there is a delay for the claim to reach the carrier via mail. Upon receipt, the mail then has to be opened, sorted, go through a manual review, and then be verified before being entered into the carrier claims software – which slows the claims processing…significantly.
  2. Generate patient statements automatically through your software. Some software can print patient statements at the office while others print and mail statements for you from the vendor’s location.
  3. Use Electronic Medical Records (EMR). There are a number of reasons why the government is encouraging the use of EMR. EMR allows offices to go almost paperless.  It reduces errors and save time and money. Electronic medical record files are easier to transfer and there is no confusion over poor physician handwriting; and if an emergency physician needs access to a patient’s medical record, an electronic medical record may be available immediately, assuming the physician and hospital are using the same database. One negative of transferring to electronic medical records is that there would be an increased possibility for unauthorized access to patient records, in violation of HIPAA. If considering a transfer to EMR, check on the security built into the system.
  4. Take advantage of Electronic Funds Transfer (EFT). EFT refers to the electronic exchange or transfer of money from one account to another; for example, from the carrier directly to the physician’s bank account.  This will decrease the time required to receive claim payment via mail.
  5. Use the reporting functionality built into your software. Most software can generate comprehensive reports to check how efficiently your office is performing.  You can check claim status, patient billing/collection information, and monitor cash collected.
  6. Outsource some of your more complicated tasks like compliance or the performance of routine audits if you don’t have the time or the experience to complete them on your own.
  7. With web-based software, sometimes known as application service providers (ASP), you can process claims or monitor claim status from anywhere.  How does sitting on the beach with an umbrella drink and checking claim status sound?  Another advantage of ASP is that the central server is located at the vendor’s location and troubleshooting and downtime is lessened.

Manage Denials Effectively for Improved Productivity

A key part of improving billing productivity is managing denials. It is widely accepted that:

  • 25% – 40% of all claims are either denied or delayed due to carrier editing
  • 50% of denied claims are never resubmitted by the practice
  • 65% of all denied claims are payable through the appeals process

Providers’ revenues are decreasing due to declining reimbursement as well as rising costs associated with claim submission and collections.  It is therefore more important than ever to manage the entire claims process to reduce or eliminate denials from the carrier.

In an attempt to get claims paid faster and reduce the risk of an audit, many providers choose to downcode their services.  This practice not only reduces a provider’s revenues but it can also be considered as insurance fraud.  Providers should submit claims based on the documentation of the services rendered in the patient chart.

Keys to Successful Denial Management

Offices should establish standard operating procedures for claims denial management.  A member of the staff, or team of staff members for larger practices, should be tasked with denial management assessment.  The process can be broken down into three main steps:

Prevention – On a regular basis claims should be reviewed prior to submission to check for errors. Any error trends should be written up for the provider to review.  All discrepancies should be discussed with the departments at regular staff meetings.  Processes should be modified to reduce errors and trends should be tracked for improvements.  Implement procedures such as:

  1. Verifying insurance coverage for every visit.
  2. Billing for medically necessary services only.
  3. Coding signs and symptoms in the office instead of “rule out” diagnoses. 
  4. Using current ICD, CPT, and HCPCS codes.
  5. Copying the patient’s insurance card and picture ID at patient registration. 
  6. Marking Box 19 with “Resubmitting Claim” or “Corrected Claim” if resending a claim.
  7. Verifying proper modifier usage.
  8. Verifying Advanced Beneficiary Notices (ABNs) are on file if there is a chance that Medicare will not pay for a service and checking that modifier –GA is used in Box 24D of the claim form.
  9. Monitoring the use of referring physician information in Box 17.
  10. Examining carrier fee schedules.  (Carriers will generally pay the lesser of their fee schedule or the billed amount, if you ask for less than the carrier fee schedule you will be paid at less than the fee schedule.)
  11. Verifying that the date of service and place of service are correct.
  12. Verifying coordination of benefits and billing the primary carrier first.

Identification – All Explanation of Benefits (EOBs) should be monitored and grouped by denial type for easier management and to prevent similar denials in the future.  Claims may be denied or reduced for a number of reasons such as:

  1. Data entry errors
  2. Incorrect or missing information
  3. Medical necessity determinations
  4. Improper diagnosis usage
  5. Improper procedure usage
  6. Improper modifier usage
  7. Diagnosis that are inconsistent with procedure (e.g., suturing a wound if the only diagnosis on the claim form is headache)
  8. Procedure inconsistent with sex of patient (e.g., giving a Prostate-Specific Antigen (PSA) test to a female)
  9. Incorrect coordination of benefits (e.g., billing secondary before primary insurance)
  10. Inappropriate unbundling  (e.g., billing for component codes when a more comprehensive code exists)
  11. Not checking local coverage determinations (LCDs) or national coverage determinations (NCDs) 
  12. Services billed previously (e.g., submitting a follow-up claim when the first claim was denied)
  13. No prior authorization for non-routine services
  14. Physician certification missing or expired

Denial Resolution Analysis – Depending on the denial reason, claims should be resubmitted or appealed promptly based on state and federal guidelines.  Appeal effectiveness should be monitored and revised as needed to maximize effectiveness.  Carrier denial trends should be monitored closely.  (e.g., some carriers prefer the use of CPT codes for injections while others prefer the use of HCPCS codes.)  Regular trend reports should be submitted to the provider by error type (demographics, CPT, ICD, medical necessity, etc.) and carrier specific errors (modifier usage, coding conventions, etc). Suggestions relating to process improvements should be included in the report (claims should be reviewed before submitting, review CCI edits with staff, etc.).

Successful denial management is not simply about appealing denials; it is about finding errors and correcting them before they become problems and getting your claims paid appropriately the first time.

In short, with a few changes offices can increase efficiency and productivity which will improve productivity and profitability.

Liz Jones, MS, CMBSI, is Academic Director of the Medical Association of Billers, a national association celebrating its 14th anniversary this year.

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Welcome to Getting Paid, a weblog by Kareo offering ideas, news and opinions about medical billing and practice management with the goal of making medical billing easier and yes, getting you paid. Visit the Product Blog for more information on our products.

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