ED Coding and Reimbursement Alert

Billers, practices must work together to ensure smooth claims processes.

Busy emergency departments that are eager to take billing operations off their plates often outsource billing to third-party firms, but jumping directly into an arrangement with a billing company requires planning to ensure operational success.

The best way to ensure that both the billing company and the ED forge a synergy is to establish parameters up-front and commit to maintaining open communication. Consider the following tips to make sure the transition is smooth for both sides.

1. Establish A "Check-in" Arrangement

Before you agree to work with a billing firm, ensure that you are on the same page about how often you'll communicate. Some practices want to chat with the biller on a set schedule, such as every Tuesday and Friday, while others want a billing business with an open-door policy.

"I believe medical practices should approach their billers just as they approach their bookkeepers, financial advisors, and accountants," said Cristiane Caleffi, CPC-A, CMBP, owner of Ike Pono Medical Billing in Hawaii. "We are the ones responsible for collecting their revenue. Ideally, in a larger setting, when the billing company designates different reps to take care of one account, they should at a minimum pre-schedule meetings to check in with one another, especially if it is a biller that is hard to reach. The frequency varies on the size of the practice."

If your practice requires the billing company to be available in the off-hours, that's something that you should mention before signing on the dotted line. "We work with many behavioral health providers and addiction rehabilitation programs, and they are usually with patients during the day," Caleffi said. "I make myself available off-hours for any questions they have. I am in direct contact with all my clients. They know I'm a phone call away and I actually answer my phone."

2. Ensure the Service Is Well-Versed in Compliance

Any billing service should be able to identify occasions of improper billing, so the service should know what to do if it uncovers instances of coding or billing problems. In fact, some billing services will even help the medical practice with its compliance program.

"We create a compliance manual for each clinic that hires us to do their billing, and it contains the seven chapters the OIG wants in there," says Bonnie J. Flom, CEO, CMRS, CCCPC, of Billing Buddies in Minnetonka, Minnesota. "We create the basic compliance manual and then I tell my clients that they need to keep working on it over time as new rules come out and changes are issued."

Because the billing firm and the medical practice are on the same side when it comes to compliance, any billing service that doesn't have compliance at top of mind may not be the right fit for an ED. "I want to audit-proof our providers," Flom says.

3. Ask How the Billing Firm Handles Potential Errors

If you hire a billing company that's well-versed in compliance, as advised above, then it's possible the biller will find instances where the ED may have billed the wrong or inappropriate code. Knowing that they are ready to handle that is important.

"Not all mistakes are frauds and the first step would be to identify the problem, cite the binding rule and propose the appropriate solution," Caleffi said. "I believe that most people are well intended until proven wrong. My first approach is based on the idea that it was an error, that if they knew better, they would do better."

If, after working with the practice, the biller still sees signs of inaccurate billing practices and suspects that the practice is purposely upcoding, they will need to take action. "Of course, if it comes to a point that they don't want to change or they keep doing it even when they know it is not right, then it is your responsibility as a professional to refuse service or you would be an active participant," Caleffi said.