Physician's Practice - November 2008 - (Page 32)

BILLING But all too often, practices have no follow-up routine for ﬁxing and submitting suspended claims in a timely manner, so these charges just loll about in the system, says Mertz. The longer they loll, the longer you wait for your money, unless claims stagnate so long that you miss a ﬁling deadline. Avoiding the problem of unresolved edits is another example of advanced billing know-how. “When the machine says, ‘We can’t send this out,’ somebody has to ﬁx this problem,” says Mertz. With many practice management systems, edits appear in real time as a biller enters charges, allowing her to ﬁx them immediately if the solution is handy. If the edits are unresolved, a good system will let you assign them to the right staffer to remedy. For example, if your edits have caught a missing insurance number, you can put the claim in a work queue for a front-desk staffer. Create a protocol for who ﬁxes what, and by when, says Keegan. “Edits should be worked as soon as they pop up,” she says. “Unless the problem is out of a practice’s control, they should be wrapped up at least within ﬁve days.” To keep everybody on their toes, Keegan advises generating a report tracking the lag time between when a dirty claim is suspended and when it ﬁnally goes to the insurer all spiffed up. report by payer.” No arguing with that axiom. You need this report to spot slow payers. But don’t stop there, says practice management consultant Judy Capko. In a group practice, age your A/R by provider, as well. Capko recalls how such an analysis tipped off a client of hers to a problem with a new doctor: One insurer wasn’t paying the doctor’s says her doctors started becoming sticklers for billing-department promptness 11 years ago, after they learned that $400,000 in charges had to be written off due to untimely filing. CONVENTIONALLY UNWISE MAKE BILLERS ACCOUNTABLE Avery ADVICE FOR SPECIALISTS Specialists worried about revenue as well as Medicare audits should examine a key metric: the volume of their ofﬁce consults compared to newpatient ofﬁce visits, says practice management consultant Sarah Wiskerchen with Karen Zupko & Associates. Why? Because consults pay 21 percent to 30 percent more; you want to bill for them whenever it’s appropriate. But be careful about overdoing it: You don’t want to trigger an audit. Average consult-to-new-patient ratios vary by specialty, according to Medicare claims data. Neurosurgeons, for example, typically bill six times as many consults as they do new-patient visits. A neurosurgeon who’s billing only three times as many consults to new-patient visits is likely coding gobs of bonaﬁde consults as new visits, and leaving money on the table, says Wiskerchen. But if her ratio is 12 to one, a Medicare auditor will wonder what’s up. “You’re going to stand out,” says Wiskerchen. There’s plenty of conventional wisdom about following up on unpaid, denied, or underpaid insurance claims. A word to the wise: Conventional wisdom needs some ﬁne-tuning. Consider this bromide: “Follow up with the insurer if it doesn’t pay a claim within 30 days.” The trouble with that advice, says Keegan, is that each insurer has its own adjudication cycle for clean claims, and it’s often shorter than 30 days, due to electronic claims submission and payment, not to mention state prompt-pay laws. That means you can get off to an earlier start, chasing down accounts receivable. “Medicare typically pays clean claims within 14 to 17 days,” says Keegan. “Some private insurers pay in 25 days. You need to determine the cycle for each payer.” Then, set your follow-up threshold by payer accordingly. If Insurer X doesn’t pay up within the customary 25 days, give it a ring on Day 26. Another piece of conventional wisdom is “Generate an aged A/R claims because his credentialing paperwork had gotten lost. “There were other ways the group could have discovered this, but the aged A/R report was the key,” says Capko. The same report can yield positive ﬁndings. Maybe one doctor collects 75 percent of his money from Insurer X within 30 days, compared to 50 percent for the rest of the group. “Find out what he’s doing right so that everybody else can imitate him,” says Capko. Practices with a large billing department often assign billers to particular payers so they can master their claims-processing quirks and get on a ﬁrst-name basis with payer reps. Such specialization has gotten to be standard operating procedure, but be careful how you divvy up payers lest you create uneven workloads, says Bee. After all, payers aren’t created equal. Some are more prone to slow-pay and denial-itis than others, which increases your work. Some conduct more of their business electronically, which streamlines it. Worker WWW.PHYSICIANSPRACTICE.COM 32 | PHYSICIANS PRACTICE | NOVEMBER 2008 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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