Physician's Practice - November 2008 - (Page 31)

BILLING the level of your billing and collection game, get your hospital act together. Part of the solution is a rounds list — which your hospital may be able to generate — that shows whom you’ve admitted, says Mertz. This list lets billers know what charges to watch for. They can hound Dr. Jones if a charge ticket on Mrs. Johnson in Room 312 never materializes. Rounding lists can be downloaded into any number of charge-capture programs — complete with coding tools — that you use on a smart phone or PDA. Some electronic medical record programs have any tests or procedures they’ve ordered. Then they thumb through the charges to make sure those tests or procedures are recorded. If they aren’t, they contact the doctor. “They understand that the billing department has the authority to call them any time of the day about missing charges,” Avery says. Accountability works in the other direction, too. One doctor, says Avery, will occasionally hold back a charge ticket on a hospitalized patient to see if billers will catch the omission. “She wants to know that you’re watching her money.” “I see too much data entry by coders,” says Bee. “Just copying information from the charge ticket into the computer is a bloody waste of their time. True, they ﬁx problems like missing modiﬁers and diagnostic codes in the process, but it interrupts data-entry, and that’s a lower-level job anyway.” Instead, “coders should review and correct all charge tickets and then hand them off to data-entry clerks.” Bee says that highly trained coders make too much money to be used for tasks that a clerk could complete. They’re better-used for “analyzing denials … writing appeal letters to insurers, reviewing insurance contracts,” and other higher-level functions that, when done well, can generate the practice big revenue boosts. For example, Bee recalls a contract that included an absurd restriction — “a limit of two diagnostic codes per claim, as if patients only had two problems.” Such an arbitrary clause could cost a practice thousands of dollars over the course of a year, yet coders might overlook this problem if their time is swallowed up by endless modiﬁer checks and tedious data-entry. “Coders also should be reviewing charge tickets each year to make sure that listed codes are up to date and the most frequently billed by the practice,” Bee adds. “I like to put those people to work with their brains, not just with their ﬁngers.” FIX YOUR EDITS QUICKLY INPATIENT CHARGES Many physicians are “notorious for writing hospital charges on napkins and turning them in late.” Greg Mertz, consultant inpatient charge-capture modules as well, giving you mobile access to patient charts. Not ready for the software approach? An alternative, says Keegan, is pairing a doctor on rounds with a nurse or certiﬁed coder — call them “humanware” — who can document services and charges. If you’re losing thousands of billable dollars scrawled on hospital napkins that get thrown away, this extra personnel cost may represent a good investment. One practice that’s taken charge of inpatient charges is 14-doctor MidSouth Pulmonary Specialists in Memphis, Tenn. It posts a master rounding list for its patients in seven hospitals on a practice intranet. Doctors are responsible for updating the list twice a day, noting all consults, follow-up visits, discharges, transfers, and deaths. Redundant systems help prevent charges from falling through the proverbial cracks. Billers scour doctors’ progress notes for references to WWW.PHYSICIANSPRACTICE.COM At Mid-South Pulmonary, physicians typically submit inpatient charges on the day of service using a printout of an individual rounding list with ﬁelds for diagnostic and CPT codes. Many of them fax or e-mail the form to the ofﬁce from their home after they’ve hung up their stethoscope. Avery says her doctors started becoming sticklers for promptness 11 years ago after they learned that $400,000 in charges had to be written off due to untimely ﬁling. “They had no idea,” says Avery. “They thought they were doing everything right.” The moral of the story? Teach physicians that discipline and sloppiness each has its financial consequences. They’ll figure out the right path to take. HAVE CODER, USE WISELY Having expert coders on staff is Billing 101. Using them intelligently is Billing 201, says practice management consultant Judy Bee. Everybody knows insurance claims shouldn’t go out the door unless they’ve been edited for possible errors — either by human eyes, or better yet, by tireless scrubbing software. These programs may come standalone or as part of your practice management system. You naturally want your system to suspend dirty claims instead of submitting them as easy candidates for rejection or denial. It’s often a matter of missing information — a modiﬁer, a diagnostic code that would support a CPT code, or the name of a referring physician. NOVEMBER 2008 | PHYSICIANS PRACTICE | 31 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physician's Practice - November 2008

Physician's Practice - November 2008 Contents Death of Solo Practice Just a Myth Letters HSAy What? Noteworthy Finding Lost Revenue: The Search for Billing and Coding Gold Getting More: Our Annual Physician Compensation Survey ’Tis the Season to be Neutral Ask the Experts Evaluating Paperless Labs HR in a Box? The Guide Coding Third-Party Audits on the Rise Branding the Cash-Only Practice Intra-Office Tug-of-Wars Stickin‘ Up For Yourself Classifieds Advertiser Index

Physician's Practice - November 2008

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