Email not displaying correctly? View it in your browser. Issue #8 — Feb 23, 2011
AAPC BillingInsider e-Newsletter

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F R O M   T H E   F I E L D

A Tip from a Colleague - Call the Payer
By Michelle Thompson, CPC

We coders and billers all dread managing our accounts receivables (A/R). I want to share a tip we find successful to help you make it somewhat easier.

My colleagues and I have entered all our surgery center's payer contracts into the system so we can reference payer write-offs when we bill. When we post remittance forms to the payer, we know if the payer's payment is correct or not. If not, we stop and call the payer when we post the payment. This helps us receive revenue due the surgery center more quickly. Implementing this process has helped to reduce the A/R and speed up payments normally delayed as a result of claims not being processed correctly.

G O O D   T I P S

Know Your Carriers' Nuances When Billing for Medicaid

When billing Medicaid, know how your carrier interprets the official code sets. Many times they want you to use HCPCS Level II codes in place of CPT® or special modifiers for payment indicators. This requires additional research to determine which code the carrier wants. By defaulting to an evaluation and management (E/M) code, you do your practice a financial disservice.

Think about this scenario: A child comes in for special screening before going on vacation with her mother. Past allegations of abuse exist. The physician must examine the child and fill out an official form - sometimes as long as eight pages - prior to the child being turned over to her mother. Many practices try to report this with an E/M service, and this may or may not get paid with a preventive diagnosis code. Whether it is paid is irrelevant if the service does not meet the definition of an E/M service. You are left wondering how to get your physician paid for all the work he or she did.

The bottom line is this: Reporting an E/M code may only get you about $30 in payment but by properly billing with the appropriate HCPCS Level II code, you are able to receive about $60. Payments and policies vary by state. Be sure to do your research; contact your payers' provider representatives, and make sure your physician receives payments to which he or she is entitled.

F E A T U R E D   S T O R Y

Check the Language in the Contract

One of the best kept secrets in billing is what might be contained in the language of your contracts with health plan carriers. The cost of collecting a $10 co-pay after the visit is usually about $8 per statement, and that doesn't include the tracking and additional phone calls necessary to collect what is a minimal amount.

Of course, it's always best (and often required) to collect the co-pay or any other fee up front. Sometimes, though, that isn't possible and you are left with pursuing two options: Attempt to collect the co-pay or write the balance off. Both cost your practice money. Before determining your solution, take a look at your existing contract. Many contracts have language that states patients must pay their portions within a specified time frame. If that contract is broken by patients not paying in a timely fashion, you may not have to write off contractual obligations but instead charge patients the co-pay and the amount of the service you wrote off due to the payer contract.

Follow these steps to reduce your collections and prevent small balance frustrations in the future.

  1. Check the language in your contracts; and, if there is no language on when a beneficiary has to pay, ask to have it clarified or added to your contracts.
  2. Once you have the language confirmed, contact patients. Let patients know they have a short period of time to pay (such as 10-15 days). Tell them if payment is not received, they will be in breach of the contract and the new amount due will be $xxx (Add what you had to write off for contractual payment.). Normally, this is a significant increase and most patients will pay quickly. Those who can't will contact you regarding payment arrangements.
  3. Follow up if you don't hear from the patient after the notification. Be sure to add the extra from the contractual obligations back on to their bill. Make a special code that spells it out to the patient where the additional cost was incurred. If you end up turning the amount over to a special collection agency, be sure to give the agency a copy of all correspondence.

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
Call the Payer
Know Your Carrier
Check the Contract

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