Download ppt - Achieving Success with Billing and Collections

Achieving Success with Billing and Achieving Success with Billing and CollectionsCollections

Presented By:Presented By:John R. Mazza, President/CEOJohn R. Mazza, President/CEO

Financial HealthCare Management, Inc.Financial HealthCare Management, Inc.1400 Johnson Avenue, Suite 4-S1400 Johnson Avenue, Suite 4-S

Bridgeport, WV 26330Bridgeport, WV 26330PH: 304-842-0307 Fax: 304-842-0315 PH: 304-842-0307 Fax: 304-842-0315

Web: Web: www.fhcm.net Email: [email protected] Email: [email protected]

BE PROACTIVEBE PROACTIVEBeing Proactive Means:Being Proactive Means:

Practices ensure that patient demographic and Practices ensure that patient demographic and insurance information is correct, so claims can insurance information is correct, so claims can be filed right the first time.be filed right the first time.

Practices collect from patients at the time of Practices collect from patients at the time of service whenever appropriate, to prevent service whenever appropriate, to prevent financial losses after care is provided.financial losses after care is provided.

Staff has the information needed to facilitate Staff has the information needed to facilitate patient education and fulfillment of insurance patient education and fulfillment of insurance plan-mandated rules and paperwork.plan-mandated rules and paperwork.

Electronic Resources for Confirming Patient Electronic Resources for Confirming Patient Eligibility and BenefitsEligibility and Benefits

Use online tools to check patient insurance Use online tools to check patient insurance eligibility and benefits, co-pay amounts, eligibility and benefits, co-pay amounts, referral requirements and claim status.referral requirements and claim status.

Armed with this information, your team Armed with this information, your team will be able to file the claim correct the will be able to file the claim correct the first time.first time.

Local Carriers currently offering this Local Carriers currently offering this service: service:

(The Health Plan, Workers Compensation, (The Health Plan, Workers Compensation, Acordia, Tricare) Acordia, Tricare)

Time of Service CollectionsTime of Service Collections

Consistent co-pay collection is a Consistent co-pay collection is a basic step that can have a big basic step that can have a big financial impact.financial impact.

Creates immediate cash flow and Creates immediate cash flow and eliminates the cost of collecting from eliminates the cost of collecting from the patient in the future.the patient in the future.

ACCEPT CREDIT AND DEBIT CARDS!! ACCEPT CREDIT AND DEBIT CARDS!!

Enforce Audit ControlsEnforce Audit Controls

Simply translated, an audit control is a Simply translated, an audit control is a process used to ensure that all of the process used to ensure that all of the services performed, and all of the services performed, and all of the payments collected in the practice, are payments collected in the practice, are properly recorded in the practice’s properly recorded in the practice’s computer system and balanced to the computer system and balanced to the bank account. A lack of audit controls is a bank account. A lack of audit controls is a common finding in practices that have common finding in practices that have experienced internal theft or experienced internal theft or embezzlement.embezzlement.

Perform a Daily ClosePerform a Daily Close (Key Steps)(Key Steps)

• Services and payments are recorded on the encounter Services and payments are recorded on the encounter form, reflecting the value of the service and amounts form, reflecting the value of the service and amounts collected from the patient.collected from the patient.

• Services and payments recorded on the encounter forms Services and payments recorded on the encounter forms are tallied manually prior to data entry, so they compared are tallied manually prior to data entry, so they compared with the information system totals after data entry.with the information system totals after data entry.

• Manual or electronic encounter forms are reconciled to Manual or electronic encounter forms are reconciled to the day’s appointment schedule to ensure that all the day’s appointment schedule to ensure that all services scheduled and performed are turned in for services scheduled and performed are turned in for billing.billing.

• Payments received in the mail are tallied by an individual Payments received in the mail are tallied by an individual other than the specialist who enters them into the other than the specialist who enters them into the information system. Any variation between the two information system. Any variation between the two values must be reconciled.values must be reconciled.

Lockbox SolutionsLockbox Solutions

A lockbox is a fee-based service offered by A lockbox is a fee-based service offered by many banks, whereby payments mailed to many banks, whereby payments mailed to the practice are directed to a bank-the practice are directed to a bank-managed post office box. Upon receipt at managed post office box. Upon receipt at the bank, payments are deposited, the bank, payments are deposited, photocopies of the checks are attached to photocopies of the checks are attached to the original EOB remittances, the EOBs are the original EOB remittances, the EOBs are tallied in batches, and the batches are tallied in batches, and the batches are forwarded to the practice. Upon receipt in forwarded to the practice. Upon receipt in the practice, payments are posted as usual. the practice, payments are posted as usual.

Track Missing ChargesTrack Missing Charges

Whether managed through a printed Whether managed through a printed report or viewed from the computer, report or viewed from the computer, the missing encounter list must be the missing encounter list must be monitored daily to highlight monitored daily to highlight scheduled encounters that did not scheduled encounters that did not have a corresponding service posted.have a corresponding service posted.

File Claims FastFile Claims Fast

Once a service has been provided, every Once a service has been provided, every day that a claim remains unbilled is one day that a claim remains unbilled is one less day that you have access to the less day that you have access to the revenue for that service.revenue for that service.

Payers continue to impose filing deadlines Payers continue to impose filing deadlines of as little as 30 days from the date of of as little as 30 days from the date of service.service.

Failing to file a claim within the designated Failing to file a claim within the designated period can result in a claim denial, and the period can result in a claim denial, and the practice cannot collect from the patient.practice cannot collect from the patient.

Develop Efficient Charge Capture ToolsDevelop Efficient Charge Capture Tools

Physicians in all specialties are using Physicians in all specialties are using personal digital assistants (PDA’s) with personal digital assistants (PDA’s) with charge-capture programs to streamline charge-capture programs to streamline hospital, surgical and office billing.hospital, surgical and office billing.

In less technologically advanced In less technologically advanced practices, simply developing a hospital practices, simply developing a hospital or surgical encounter form will assist or surgical encounter form will assist the billing staff in getting claims billed the billing staff in getting claims billed promptly. promptly.

File Electronically When You Can, File Electronically When You Can, and Work the Electronic Editsand Work the Electronic Edits

Despite the prevalence and acceptance of Despite the prevalence and acceptance of electronic claims, we continue to see electronic claims, we continue to see practices relying on paper claims. MAKE practices relying on paper claims. MAKE THE CHANGE !THE CHANGE !

For practices currently submitting For practices currently submitting electronically, your staff should be working electronically, your staff should be working the electronic edit report daily. This report the electronic edit report daily. This report highlights claims that contained errors and highlights claims that contained errors and were rejected by the electronic claims were rejected by the electronic claims vendor.vendor.

Reinforce Timely Filing Deadlines and Reinforce Timely Filing Deadlines and Track Adjustments RetrospectivelyTrack Adjustments Retrospectively

Do not let your practice be subject to Do not let your practice be subject to losses that can be prevented with losses that can be prevented with physician and staff education.physician and staff education.

Post lists of payer filing deadlines.Post lists of payer filing deadlines. Track and monitor the dollar amount Track and monitor the dollar amount

of any claims denied for reason of of any claims denied for reason of “Timely Filing” each month.“Timely Filing” each month.

Use Electronic RemittanceUse Electronic Remittance

Electronic remittance is a process Electronic remittance is a process whereby payments and adjustments whereby payments and adjustments are conveyed back to the practice’s are conveyed back to the practice’s information system electronically information system electronically from the payer, eliminating the need from the payer, eliminating the need for manual data entry.for manual data entry.

Process Patient Statements Process Patient Statements Bi-MonthlyBi-Monthly

Processing patient statements in bi-Processing patient statements in bi-monthly batches, instead of one monthly batches, instead of one large batch each month helps the large batch each month helps the practice to even out the patient practice to even out the patient question calls that result on receipt question calls that result on receipt of their bills.of their bills.

Cash flow can also improve and Cash flow can also improve and become more predictable and become more predictable and consistent.consistent.

Review and Correct EOB Denials Review and Correct EOB Denials PromptlyPromptly

The first step in managing patient The first step in managing patient accounts is to review and resolve the accounts is to review and resolve the claims that are highlighted in EOB claims that are highlighted in EOB remittances returned unpaid by the remittances returned unpaid by the insurance carriers.insurance carriers.

Don’t spend hours on the phone Don’t spend hours on the phone researching the reason for denial. researching the reason for denial. The answer is usually on the The answer is usually on the remittance. remittance.

Follow up on Accounts by Age and Follow up on Accounts by Age and Dollar ValueDollar Value

Get the best and most return for your Get the best and most return for your effort.effort.

Work accounts by highest dollar Work accounts by highest dollar claims.claims.

Work accounts by time sensitive Work accounts by time sensitive payer types.payer types.

Inquire about multiple claims on the Inquire about multiple claims on the same phone call or check claim status same phone call or check claim status electronically on multiple accounts electronically on multiple accounts from the payers web site. from the payers web site.

Don’t Forget to Work Credit Don’t Forget to Work Credit BalancesBalances

Credit balances are a two-pronged Credit balances are a two-pronged problem for practices.problem for practices.

• First, they understate the value of First, they understate the value of the accounts receivable by offsetting the accounts receivable by offsetting unresolved accounts.unresolved accounts.

• Second, they represent a liability to Second, they represent a liability to the practice; if claims are paid twice the practice; if claims are paid twice by insurance carriers or patients, by insurance carriers or patients, that will money will need to be that will money will need to be refunded.refunded.

Train and EducateTrain and Educate

Coding and modifiers. Coding and modifiers. Are claims Are claims being denied as bundled, lacking being denied as bundled, lacking medical necessity or lacking supporting medical necessity or lacking supporting documentation? Do EOB’s show line documentation? Do EOB’s show line items with zero payment? Have those items with zero payment? Have those responsible for coding ever attended a responsible for coding ever attended a formal coding workshop focused on formal coding workshop focused on your specialty? Do physicians your specialty? Do physicians understand evaluation and understand evaluation and management criteria? management criteria?


Reimbursement guidelines. Reimbursement guidelines. Does Does staff have access to tools that outline staff have access to tools that outline payer reimbursement guidelines (e.g. payer reimbursement guidelines (e.g. Medicare’s Correct Coding Initiative, Medicare’s Correct Coding Initiative, Medicare Part B News and other Medicare Part B News and other carrier bulletins) to effectively direct carrier bulletins) to effectively direct their appeal efforts? their appeal efforts?


Information system.Information system. Has staff Has staff received updated training from the received updated training from the information system vendor on system information system vendor on system features and reports? Does staff features and reports? Does staff respond, “We can’t get that from the respond, “We can’t get that from the system,” when you request data related system,” when you request data related to billing and collections? Does staff to billing and collections? Does staff have access to automated coding have access to automated coding programs that eliminate the need for programs that eliminate the need for multiple manuals?multiple manuals?


Internet. Internet. Does staff have access to Does staff have access to Internet-based resources that will Internet-based resources that will support their efforts to be proactive support their efforts to be proactive and efficient? Is the team trained to and efficient? Is the team trained to navigate the Web to access Medicare navigate the Web to access Medicare and other payer guidelines?and other payer guidelines?

Monitor Results “Key Indicators”Monitor Results “Key Indicators”

Gross collection percentage. Gross collection percentage. Helpful internal measurement of Helpful internal measurement of contract profitability; not useful in contract profitability; not useful in benchmarking to others.benchmarking to others.

Total Receipts – RefundsTotal Receipts – Refunds

Total ChargesTotal Charges

Target Level: Varies based on fee Target Level: Varies based on fee schedule and payer reimbursement schedule and payer reimbursement levels.levels.


Net Collection Percentage. Net Collection Percentage. Measures Measures success in collecting collectable dollars.success in collecting collectable dollars.

Total Receipts – RefundsTotal Receipts – RefundsTotal Charges - Contractual AdjustmentsTotal Charges - Contractual Adjustments

Note: Collection Transfers and Bad Debt Note: Collection Transfers and Bad Debt Write Offs should not be included in Write Offs should not be included in Contractual Adjustments total. Contractual Adjustments total.

Target Level: 95 – 100 percentTarget Level: 95 – 100 percent


Days in Receivables. Days in Receivables. Measures how Measures how long, on average, it takes to get a claim long, on average, it takes to get a claim paid.paid.

Total Accounts ReceivableTotal Accounts Receivable

Average Daily Charges*Average Daily Charges*

*Total Charges/365*Total Charges/365

Target Level: 30 – 45 Days. (Based upon Target Level: 30 – 45 Days. (Based upon payer mix and mandated claim payer mix and mandated claim deadlines)deadlines)


Percentage of A/R over 90 Days. Percentage of A/R over 90 Days. Shows relative age of accounts Shows relative age of accounts receivable; as accounts age they receivable; as accounts age they become more difficult to collect.become more difficult to collect.

Accounts Receivable Over 90 Days OldAccounts Receivable Over 90 Days Old

Total Accounts ReceivableTotal Accounts Receivable

Target Level: 20 – 25 percent or lessTarget Level: 20 – 25 percent or less

ConclusionConclusion

Set clear goals and expectations to Set clear goals and expectations to your staff.your staff.

Provide necessary training when Provide necessary training when errors are identified.errors are identified.

REWARD exceptional and REWARD exceptional and consistently good staff efforts.consistently good staff efforts.

GOOD LUCK AND THANK YOU GOOD LUCK AND THANK YOU