Medicare Compliance & Reimbursement

Make a big difference to your practice’s bottom line with smart relationship management.

Even if your physicians and billers are extremely busy, they must maintain a healthy line of communication to ensure services get billed appropriately. Improved communication can reduce claim denials and help improve documentation required to support claims.

The first thing a biller must do is figure out the best way to communicate with the physicians in your practice. It may be in person, or email, or notes written on the chart and placed in his stack of charts to review, or even a phone call or page if it’s really important. The key is to find something that works and stick with it. Physicians like consistency.

Another good way to keep physicians and billers working together is to hold monthly or quarterly meetings between the two. These meetings can be used to address large issues, such as having physicians explain a new procedure or having billers explain a change to the code for an existing one.

These discussions are extremely important, because they illustrate to the physicians how vital it is that they communicate with billers. For example, say a cardiology practice hires an electrophysiologist and doesn’t tell the billing office. EP services often get denied for medical necessity. How is the billing office going to work those denials if they don’t know anything about what EP is, or even that EP exists? Further, if the EP physician doesn’t understand what a claim denial is, he probably won’t be able to document appropriately to support an appeal.

Another effective communication tool involves regular financial reports. The biller should periodically produce reports on things like the top five payers, the top five drugs/procedures being used and procedure analyses on a new code. Most practitioners seem to really appreciate reports that give them financial or statistical data for their practice.