Physicians Practice - June 2008 - (Page 49) ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED COORDINATION OF BENEFITS; TAKING CHARTS WHEN LEAVING A GROUP; EMPLOYEES WAIVING HEALTH BENEFITS; EOBs AND OPTICAL CHARACTER RECOGNITION DAYS IN A/R IN GENERAL OR BUCKETS Q We went to a billing seminar, and they recommended benchmarks. One of those benchmarks was days in accounts receivable (A/R) calculated by dividing total A/R by 365 days. We were told the result should be less than 45 days. Is this standard? but you don’t want to forget about those that are older. Are you making some billing error that is leaving those accounts out there that you can correct moving forward? Are they patient accounts you really should be collecting at time of service? You can use the data to identify problems and solve them proactively. KNOWLEDGE IS POWER Why find out how much is in each bucket versus looking at the aggregate? Because more information is better. A The industry standard is to measure in 30-day increments as follows. I also note the percent of accounts you might expect to fall into each bucket, based on median benchmarks for internal medicine from the Medical Group Management Association: 0-30 Days: 65.47% 31-60 Days: 13.45% 61-90 Days: 6.13% 91-120 Days: 11.49% Why find out how much is in each bucket versus looking at the aggregate? Because more information is better. Say the average is 46 days; to understand it you’d need to dig deeper anyhow. Plus, the majority of accounts should be in before 45 days, MANAGING TAKEBACKS AND COORDINATION OF BENEFITS Q I provided care to an elderly man and was reimbursed by our area Blues plan. The man had applied for and was eventually granted Social Security Disability and with that Medicare retroactively became the primary payer for the claims for which I’d already been paid. The Blues plan then demanded repayment from us. We paid them. Then we filed claims for these services with Medicare explaining in great detail with a copy of the explanation we’d received from Blue Cross the reason why we were past the 90-day limit in filing. Medicare denied the claims anyway on the basis of lack of timeliness without comment on our explanation. What am I supposed to do? A Here’s how it would have gone, ideally: The insurance company asks for the money back. You respond within 30 days to say “Okay, we’ll submit to Medicare and get back to you.” Medicare denies the claim. You send the denial to the insurance company. The insurance company settles or sends the patient a notification that they won’t pay and then you bill the patient. In other words, you should not have repaid the Blues plan before going to Medicare. This may help in the future. On this claim, for now, the only thing you can do is bill the patient along with a letter asking the patient to appeal Medicare’s denial. This will help, and hopefully allow for Medicare to overturn the “timely filing” issue. That is, it isn’t a timely filing issue, it is a coverage of benefit issue, and Medicare would rather fix the claim than penalize the patient. But, until the patient gets involved, it’s all too easy for the payers to keep denying. Thanks to Susanne Madden, The Verden Group, for this answer. CHARGING PHYSICIANS FOR CHART SUMMARIES Q I am incurring a lot of expense and time personally reviewing patient charts and narrating patient summaries in response to other physicians’ requests for copies of patient records. Can I charge the other physicians for the processing time involved for my staff to retrieve and copy the patient records, as well my time to review the patients’ charts and narrate written summaries for the requesting physicians? Does HIPAA or some other rules set limits of what I can charge? 49 WWW.PHYSICIANSPRACTICE.COM JUNE 2008 | PHYSICIANS PRACTICE | http://WWW.PHYSICIANSPRACTICE.COM
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