Do you know a biller who might appreciate this newsletter?
F R O M T H E F I E L D
It Takes an Office: Keeping A/R Days Down
By Jacqueline Stack, BSHA, CPC, CPC-I, CEMC, CFP, CIMC, CPEDC, CCP-P
Account Receivables (A/R) are a critical part of the revenue cycle. How can you keep the denials and your A/R days down? How can you incorporate the other departments in the office to help?
From the time the patient calls your office for an appointment until the time the claim is paid, there are many opportunities to assure accuracy. Getting the right information from the patient is a critical piece. Here are tips to make sure that you are getting the information right. Let's start with the front office.
1. Frequent Reminders to bring current insurance cards, copayment (if they have one), and payment if they have no insurance:
- When the patient calls to set up the appointment remind them
- If you have an automated phone system, incorporate a message that plays when the patient calls in
- Appointment reminders
2. Update information with the patient at each visit:
- Have the patient show insurance cards each visit
- Front staff needs to double check the information
- Check eligibility
3. Collect copayments and balances
- Collect copayments at check-in and check-out
- Advise the patient of balances
The back staff can also help with the reminders. Sometimes the patients do not give the full story to the front staff when making an appointment or at check in. But when the patient gets back with the clinical staff the story is much clearer.
For example: Mary Smith calls and makes an appointment for a headache. When the patient checks in she gives her health insurance to the front staff. When she gets back with the nurse she states that she has had a headache since yesterday when she was involved in an auto accident.
At this point, because the nurse has had the proper training, she advises the patient that this would need to be billed to her auto insurance and either gets the auto information from the patient, notifies the front staff who gets the auto information from the patient when she checks out, and/or notifies the billing department so that they can make sure that the right insurance is being billed.
Try out these tips and techniques to help cut down on denials and decrease the amount of time it takes to get the claim paid.
G O O D T I P S
Scope of Liability for Billing Services
By Ken Camilleis, CPC, CPC-I, CMRS
According to the HIPAA Privacy Rule, covered entities (CEs) such as hospitals, physicians, clearing houses, and certain insurance payers are obligated to safeguard individually identifiable health data, known as protected health information (PHI). The HIPAA Security Rule extends liability of CEs to PHI transmitted in an electronic format (ePHI). HIPAA also defined business associates (BAs) as entities that work as "trading partners" with CEs, and medical billing services under this definition are classified as BAs. Unlike CEs, BAs were initially exempt from HIPAA statutes, but that has changed.
One provision of American Recovery and Reinvestment Act (ARRA), passed in January 2009, called Health Information Technology for Economic and Clinical Health (HITECH) contains a stipulation about BAs such as billing companies now being liable for actions under HIPAA for such acts as breach of PHI/ePHI. This raised a stir among billing agencies as to the scope of responsibility under HITECH and also raised the question as to whether independent billing services can be cited under the False Claims Act if a client commits fraud.
There's one missing link in the life cycle of the administrative process, and that's the coder. Independent billing companies do not always have coders on staff; neither do they have ready access to their clients' medical records. Coders are usually employed by their provider, and they abstract information from the doctor's notes to determine the appropriate codes to be designated on the superbill. Billing companies serve as a pipeline to the payer, and are not typically vulnerable to false claim charges. However, if the billing company does provide coding services, such as documentation integrity review or code verification, its billers may be liable in the case of an OIG or payer audit should one uncover an act of fraud such as upcoding or unbundling.
Under HITECH, if an independent billing company receives PHI such as on paper registration forms, superbills, and referral forms, it must protect such information, including proper waste destruction with shredders and/or the use of a certified data destruction company. If the billing service handles ePHI, it must ensure that it has appropriate safeguards (such as firewalls and encryption/decryption) as required by the HIPAA Security Rule, and follows proper procedures for certain destruction or initialization of data-storing media.
F E A T U R E D S T O R Y
Looking Inward: Internal Audits
A busy practice encounters a variety of costs in the day-to-day business of operating a clinic. For practices that provide costly medications or medical devices it is important to take steps to make sure these charges are captured and billed to insurance or patients for reimbursement. Some costs may seem minimal but add up over time. A focused audit could identify a significant loss of revenue.
Start by looking at invoices for one or two of the more costly devices used in the practice. Intrauterine devices (IUDs) are one expense in a gynecologic or family practice setting that should be monitored closely. Initiate a tracking system to make sure charges are posted for both the device (J7302, J7300) and the insertion of the device (58300).
Deciding on a procedure or service to monitor is not difficult and can identify significant financial windfall. Think through your appointment schedule and the services provided in the clinic. Here are some examples to start you on the road to recovery:
- Make sure that injectables are billed with the correct units and the method of administration.
- Run utilization for diagnosis of UTI (599.0), verify billing of UA. (81000-81003)
- When Gyn procedures (LEEP, colposcopy, cervical biopsy) are performed in the office, verify billing of pregnancy test (81025).
- Run utilization of joint injections (20600-20610) and verify accurate units of therapeutic agent. (J3301, Kenalog per 10 mg).
Capturing all charges is vital to the financial wellness of the practice. Evaluating the results of your audit may indicate a need to establish or fine tune clinic processes or re-training of staff. If you lack resources to do these audits, AAPC can help you. Call us.
FROM THE FIELD is thoughts and experiences from you the reader. If you have any tips, ideas, case studies, or just anecdotes please submit them to us for future editions.