Email not displaying correctly? View it in your browser.

Issue #24 - June 27, 2012

AAPC BillingInsider e-Newsletter

F R O M   T H E   F I E L D

Great Customer Service Equals Profitability
By Melissa Corral, CPC

Does great customer service really equal profitability? There is a direct correlation. Let's explore why.

It starts with the front office staff. These are the people patients and their families—your customers—see when they first walk through the door. They also are likely to be the last people customers see before leaving.

All staff members should have a thorough knowledge of office policies and procedures, to maintain the consistency and efficiency customers have come to know and respect. This is true not only in health care, but in any service industry. With an efficient process in place and a knowledgeable front office staff, the customer will be more understanding when it's time to collect co-pay, deductible, or balance due. Great customer service makes customers more inclined to pay the office, whether prior to or after seeing the medical provider, or when the bill comes in the mail, which improves profitability.

Now, let's consider the rest of the office staff. Customers are looking for a positive and personal experience, even while feeling their worst. Nurses, managers, billing/clerical staff, and clinicians are all involved in the customer's experience. Patients are more willing to discuss concerns freely when they receive consideration for their privacy. They generally do not want to discuss health and financial concerns in front of other patients, such as when checking in or checking out.

At this time, it's important to focus on the customer's needs, the reason for the visit, and on making the overall office experience exceptional, all of which result in positive word of mouth. This leads to increased patient volume and profitability.

Something rarely thought of as customer service—but which you ignore at your peril—is marketing to your existing strengths. This may seem like a no brainer; however, some practices focus so much on new services or products offered through the office, they overlook the established services getting high praise and feedback.

By gathering information, such as customer satisfaction surveys and basic patient demographics, medical offices can improve profits by reducing unnecessary expenses. For instance, surveys may compare direct mailings versus emails to see what the customer prefers. Surveys may also discover an increase in patients' use of social media to gain insight into physicians and medical practices, which cost little for the office to monitor and maintain.

Ultimately, all positive marketing will improve the office's profitability. Above all, great customer service is the best way to see that increase in the office's bottom line.

G O O D   T I P S

Pitfalls in Electronic Claims Filing May Cost Your Office Big Dollars
By Deli Parham, CPC

With advances in technology and government regulation, most carriers are switching to electronic claims filing and electronic remittance advice. You could end up losing big dollars if you rely on "the System" to do the work for you.

Myth: Everything is faster and easier with electronic claims filing and remittance advice. You will save money by reducing manpower time and snail mail response time.

Don't assume all of your work is done with a click of the mouse. You may not always be prompted when your claims are caught in a trap and never make it to the carrier. Here are ways to keep the revenue in your bank instead of leaving it with the insurance carrier.

1. Keep a close eye on claims filed electronically.

  • Make sure you get confirmation that claims were processed by your clearinghouse and reached the carrier.
  • Watch for error messages from the clearinghouse and payer.
  • Work all rejections immediately; otherwise, they could fall through the cracks.

2. Run an aging of all accounts a minimum of every three months, but preferably monthly.

  • Look for large amounts not paid in your 60-day aging column.
  • Check service dates of claims with large amounts not paid. When there are many claims outstanding with the same service dates, more than likely these claims never reached the payer.
  • Re-file all of these claims immediately, even if some or all may be duplicates.

3. File in a timely fashion. Many payers (e.g., United Healthcare and Cigna) have a 90-day filing deadline.

  • Re-filing claims immediately prevents missing these short timely filing deadlines.
  • Missing a timely filing deadline could mean spending more to get a claim reimbursed than the claim itself is worth.
  • Most payers will not reimburse these claims unless you can prove the payer received the claim. Electronic confirmation that claims reached the clearinghouse isn't enough.
  • Prevent high write-offs: This is your error and cannot be billed to the patient.
  • If you bill patients for your mistake, you will have angry (or no) patients.

4. Append proper Place of Service.

Find out if your system is capable of changing the Place of Service, especially if your office performs procedures in different locations. For example, procedures performed in an office setting are always billed with the place of service 11. Procedures performed in a facility, hospital inpatient are reported with place of service code 21; an ASC is 24; and a nursing home is 32. The amount reimbursed for each could be more or less, depending on the location.

5. Be right about diagnosis codes.

  • Link the proper diagnosis codes to the procedure codes.
  • Payers use the diagnosis codes linked to the procedure code to process claims.
  • Payers usually use only the first two diagnosis codes (the primary and underlying) when processing claims.
  • Additional diagnosis codes may be used for informational purposes only, or are not considered at all.

If you do not watch, errors may deter cost savings, which could send your practice into bankruptcy.

Medicare Wants Comment on Changes to Secondary Payment Rules

The Centers for Medicare & Medicaid Services (CMS) has tossed seven options out to modify its Medicare Secondary Payer rules and requests comments by August 14 and these may affect billing.

The seven proposals, published in the June 15 Federal Register, provide standardized options for beneficiaries to manage any settlements relating to workers' compensation, auto, and liability insurance in the future. Federal law requires that Medicare recover any money spent for care as a secondary payer before a settlement is dispersed.

The seven options are these:

  • The individual or beneficiary pays for all related future medical care until his or her settlement is exhausted and documents it accordingly.
  • Medicare would not pursue "future medicals" if the individual or beneficiary's case fits a number of conditions in the proposal.
  • The individual or beneficiary acquires and provides an attestation regarding the date of care completion from the treating physician.
  • The individual or beneficiary submits proposed Medicare Set-Aside Arrangement (MSA) amounts for CMS' review and obtains approval.
  • The beneficiary participates in one of the Medicare's recover options.
  • The beneficiary makes an up-front payment.
  • The beneficiary obtains a compromise or waiver of recovery.

For more information, consult the Federal Register.

F E A T U R E D   S T O R Y

Medicare's "4G" Modifiers: When Can You Bill the Patient?
By Nancy Clark, CPC, CPC-I

Every biller should know the importance of issuing an Advanced Beneficiary Notice of Noncoverage (ABN) to a Medicare patient. This guide will help you to accurately append the "4G" Modifiers: GA, GX, GY, and GZ.

The ABN is a written notice that a physician, provider, or supplier gives to a Medicare beneficiary before items or services are furnished when the provider believes that Medicare will not pay for some or all of the items or services. You can download the current version of the ABN and instructions here.

There are four common modifiers that can be appended to the procedures that may be denied. Depending on the service provided and specific circumstances, the modifier can be either required by Medicare or voluntarily appended.

The first two modifiers are applied when Medicare is expected to deny the service or item as not reasonable and necessary.

  • GA: Waiver of liability statement (ABN) issued as required by payer policy, individual case
    • GA is used to report that a required ABN was issued for a service and is on file.
    • Medicare systems will automatically deny these services and assign liability to the beneficiary.
    • Because the provider obtained an ABN, he can bill the patient for this service.
  • GZ: Item or service expected to be denied as not reasonable and necessary
    • GZ indicates an ABN was not issued for this service.
    • Medicare will automatically deny these services and indicate the beneficiary is not responsible for payment.
    • Because the provider did not obtain an ABN prior to performing the service, he cannot bill the patient.

These modifiers may be used, for example, if a procedure does not meet medical necessity as determined by a Medicare Local Coverage Determination (LCD) or National Coverage Determination (NCD).

The remaining two modifiers may be appended for items or services statutorily excluded from the Medicare program. Here, the use of an ABN is optional, but provides proof the beneficiary understands he will be liable for payment for these services.

  • GX: Notice of liability issued, voluntary under payer policy
    • GX is used to report that a voluntary ABN was issued for a service that is statutorily excluded from Medicare reimbursement.
    • Medicare will reject non-covered services appended with GX and assign liability to the beneficiary.
  • GY: Item or service statutorily excluded or does not meet the definition of any Medicare benefit
    • GY is used when a service is excluded by Medicare and an ABN was not issued to the beneficiary.
    • Medicare will deny these claims and the beneficiary will be liable.

Examples of appropriate use include cosmetic surgery and determination of refractive state for the purpose of prescribing eyeglasses. Modifiers GX and GY are informational only. When using either modifier, the provider can bill the beneficiary.

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.

In This Issue
Great Customer Service
Electronic Claims Pitfalls
Medicare Comment
Medicare's "4G" Modifiers

Don't underestimate the importance of policies and procedures in the billing world.

Save time hunting down information for specific payer policies. We've compiled localized data from over 500 health plan's websites into an easy-to-use search tool.

Do you know a biller who might appreciate this newsletter?

The AAPC BillingInsider e-Newsletter is offered as a benefit to AAPC customers and we hope you find the information useful. If you'd rather not receive future BillingInsider e-Newsletters, please log in to your account and change your email preferences.

2233 S Presidents Dr., Suite F | Salt Lake City, UT 84120 | (801) 236-2200

Copyright © 2012 AAPC - All rights reserved.CPC®, CPC-H®, CPC-P®, CIRCC®, and CPMA® are registered trademarks of AAPC.

CPT® codes Copyright 2011 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.