Email not displaying correctly? View it in your browser. Issue #6 — Dec 22, 2010
AAPC BillingInsider eNewsletter

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F R O M   T H E   F I E L D

Communicate Cost for Satisfaction

Working with patients to assure everyone is accountable for the cost of care is essential to the success of a practice. Just as important is working out the processes and communications so that all are satisfied, which can assure patient retention. Here are two readers' best-practice recommendations:

"Five years ago we implemented refined collection practices which made a substantial difference in our cash flow. We started by verifying all patients' insurances prior to the date of service. We then ascertained the amount of co-pays and/or deductibles that are the patients' responsibilities at the time of service. All current contracts and spread sheets of allowable per payer were reviewed. This was followed by staff training to calculate out-of-pocket percentages. A substantial impact on patient responsibility was then noted. Early notice to patients of their financial obligation has increased prompt collections. Payment plans are implemented for three months. Statements are sent bi-weekly. These processes have improved overall cash flow and reduced our account receivables."
—Michele Thompson, CPC
Gainsville, GA

"Our obstetrics and gynecology practice is set in a community that has a high unemployment rate, which means people want to have surgery but may not come up with the money. Our practice originally would schedule the patients' elective surgeries and require their portion of the payment be collected the Wednesday prior to surgeries which would be done on the following Monday. Patients were not paying but still getting their surgeries or the patients would call and cancel their surgeries last minute because they could not come up with the money. This would not allow us enough time to fill the doctors' schedule again.

"Surgery scheduling is not a quick process and neither is cancelling. To help combat the cancelling and the wasting of employees' and doctors' time, we changed how we set up surgeries. We now verify the patients' benefits prior to calling them. After verification is complete and we know the patients' responsibility according to our fee schedule, we contact and inform them of their amount due. We inform them at that time we are unable to schedule until we receive their investment portion.

"Since we started this policy, we have only had a couple of patients complain. When this happens, we explain why we created the policy and they understand. It has helped with efficiency of the employees' and the doctors' schedule to remain consistent without many cancellations."
—Kristin Terry, CPC
Spring Hill, FL

G O O D   T I P S

Office Visit Co-Pays: Set a Policy for Positive Gain
By Jill Young, CPC, CEDC, CIMC — East Lansing, MI

Are you aggravated by accounts with small balances as you work your receivables; those small balances that show up on your reports as co-pays that were not collected at the time of service? If your office doesn't have a policy for collection of co-pays BEFORE the patient is seen, now is the time to start. The expense of statements and working accounts receivable to collect these balances is money that may not offset that $10 or $25 co-pay you're chasing.

As an instructor, I polled my students during the past five years for their office policy. In that time, the percentage of offices collecting co-pays at the time of check-in has increased from about 15 percent when I started tracking to more than 75 percent in 2010. All agree it was a worthwhile change.

Today's difficult economic times have left many patients with higher co-pays, deductibles, and even no insurance. Then, there are the Health Savings Accounts (HSAs), which present their own challenges to your collection process.

To ensure a successful transition to this new office policy, start three months prior. A letter to patients explaining your office's new policy as you attempt to keep costs down in the current economic environment works to notify and prepare patients for the change. Also, posted notices and statement messages in the reception area can increase awareness for your patients. It's best to only collect co-pays that are a set known amount (e.g., $10 or $25). The increase in front desk cash flow and the decrease in back office accounts receivable work will result in a net positive for any practice.

F E A T U R E D   S T O R Y

Quantity Counts — Make Sure You Bill Accurate Amounts
By Melissa Brown, CPC, CPC-I, CFPC — Jacksonville, FL

As codes change for 2011 next week, make sure you actively look for changes related to quantities in the codes. HCPCS Level II drug codes are particularly ripe for error if you aren't checking carefully. Some simple checks will help improve billing for quantity-based codes.

Check the Math and Look for Coding Changes

To assign HCPCS Level II codes, calculate units billed from how the drug is supplied and the amount given to the patient. Recognize that the dosage unit administered or listed on the package doesn't always match the billing unit.

Here's an example: A total of 500 mg of tetracycline is given to a patient. The code is J0120 Injection, tetracycline, up to 250 mg. To capture the full payment for the drug administered, J0120 should be billed with 2 units.

The conversions aren't always straightforward. Consider the patient to whom two 2 mL syringes containing 1,200,000 units each of Bicillin C-R are administered. The code for this is J0559 Injection, penicillin G benzathine and penicillin G procaine, 2500 units. The biller converting this information must make two calculations — one for the two vials and one to convert the vials to units.

The total amount injected is 2,400,000 units (1,200,000 X 2). Next the number of units administered must be converted to billing units. The billing unit in this example is 2500; therefore, the bill should reflect J0559 with 960 units (2,400,000/2,500 = 960). As of January 1, 2011, this example changes again since J0559 has been deleted and replaced with J0558 Injection, penicillin G benzathine and penicillin G procaine, 100,000 units making the units to bill for the same injection only 24 (2,400,000/100,000=24). This is a prime example of why you need to check for coding changes.

Know What You're Reporting and Where

Remember to report the National Drug Code (NDC) and units on the claim. The unit number with the package (and its NDC) doesn't always match the billing unit. In our example, the billing unit was 2500. The medication was provided in 2 mL syringes, so the NDC units would be reported as ML4 since each syringe contained 2 mL.

Don't Eat the Waste

Leftover units not administered from the drug's package are referred to as waste. Rather than eating the cost of the waste units, report them on a separate line with modifier JW Drug or biological amount discarded/not administered to any patient. You may be able to recoup the cost of the drug that can't be used on other patients. Make sure details relating to the amount given and cause for the waste amount are well documented.

Why Math Matters

You can see why it's important to capture every opportunity to recoup the cost of drugs and biologicals. It's equally important to check the changes to assure you aren't inadvertently overbilling either. Mistakes that over-report the units raise red flags and put a practice at risk for charges of fraud. Taking time to understand how to account for and report billing units and NDC units is crucial in making sure you get every penny due.

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
Communicate Cost
Office Visit Co-pays
Quantity Counts

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

HEALTH PLAN POLICY SEARCH TOOL
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