Pediatric Coding Alert

Easy and inexpensive to implement, you’ll benefit from instituting these expert pointers.

The calendar has officially turned, and it’s a good time to solidify your resolution to collect more money for your practice in the New Year. We’ve partnered with two billing experts to get the tips that can help you stop making billing errors and start collecting more revenue in 2016.

This Simple Step Can Help Avoid Skyrocketing A/Rs

You may think that you need to invest in an expensive accounts receivable (A/R) software program or hire pricey consultants to increase your A/R, but there’s one tip that can help you collect more income and won’t cost you a dime, says Manny Oliverez, CPC, CEO of Capture Billing and Consulting, Inc. in South Riding, VA.

“One of the biggest problems I see in some of the medical practices we start to work with is that incorrect patient information was entered into the computer system,” he says. “Misspelled patient names, wrong dates of birth, typos in the insurance ID number and secondary insurance put in as primary all lead to the claims being denied. This causes the accounts receivable to skyrocket and spiral out of control.”

Not only does this issue create denials, it can sometimes have an impact far beyond that one patient encounter. “Often the problem gets so overwhelming the denials are hardly worked all leaving thousands, if not tens of thousands of dollars on the table,” Oliverez says. “Take care of this one problem and income is sure to rise.”

Don’t Be Shy About Billing Patients

Another area where practices can quickly and inexpensively make an impact involves approaching patients for their portion of the balance. Oliverez sees dozens of practices that don’t have a quality patient collection process, which has become more important than ever as deductibles rise.

“I’ve come across practices that haven’t billed patients in months—one had actually never billed any patients at all,” he says. “The front desk should have procedures in place to collect all copays and balances at the time of service. The billing department needs policies on when and how many patient statements to send, when to mail out demand letters, how many phone calls to make and (if appropriate) when to send an account to collections. And it all needs to be done consistently.”

For example: Say your patient has a $200 deductible. Suppose you fail to collect the deductible for just two patients a day. In February alone, this will cost you $8,400, assuming your practice is only open on the weekdays.

Takeaway: Since most practices can’t afford to simply write off over $8,000 a month, now is the time to establish a process of billing patients on the day of the visit, as well as one to ensure you send them bills for any balances afterward.

Ensure That You’re Getting Contracted Amounts

Another big area where practices lose money consistently is in reconciling payments against the corresponding contracted fee schedules, says Vinod Gidwani, founder of Currence Physician Solutions in Skokie, Ill. Once you contract with a payer, you should expect to receive the contracted amounts for all of your services—but you can’t simply trust the insurer to send you those fees. You should double-check your receivables and ensure that you are collecting exactly what you agreed to when you signed the contract.

“In 2016, practices should review all their managed care contracts and take a sample of some payments from all insurance companies and match the payments against their respective contracted fee schedules,” says Gidwani, whose company measures the financial performance of medical practices to ensure that their billings are optimal. “Any discrepancies must be brought to the attention of the insurance company and if the situation warrants, the practice should request a re-adjudication of claims paid incorrectly.”

Example: Suppose the insurer is shorting you $1.00 every time you report 99213. If you bill this code five times a day, you’re losing $1,300 a year due to that simple oversight.

It is also important to ensure physicians are credentialed correctly for all locations of the practice, Gidwani adds. “With all the new insurance companies competing in the marketplace under the Affordable Care Act, accurate credentialing will avoid claims being denied. The practice should also check all the insurance websites it has contracted with, to make sure all the physician names appear on the website under the ‘Doctor Search’ button.”

Pre-Check Eligibility

In addition to being a watchdog over your payers, you should also enact a few standard practices within your medical office to ensure you are prepped and ready to collect the maximum amounts that you’re due, Gidwani says.

One area where you can capture payments from the get-go is to check patient eligibility before they present to your practice, he advises. “It’s equally important to look at those eligibility reports—they have a wealth of information on benefits, deductibles, co-pays, etc.,” he advises. “Having this knowledge prior to the visit empowers the front desk to set the right expectations on collecting balances from the patient. It is also important for the practice to have a clear financial policy that is communicated effectively with the patient.”

In addition, insurers may require pre-authorizations for services that they previously did not, which could end up costing you down the road if you don’t comply. “The expansion of Medicaid to managed care as well as the proliferation of Medicare Advantage plans now require prior authorizations for many services rendered,” Gidwani says. “The practice should know when prior authorizations are required and ensure they get these authorizations prior to the service being rendered.” This would be common in a pediatric GI or pediatric pulmonary practice, but not typically in a general pediatrics office since most pediatricians don’t perform complex procedures.

Don’t Let Denials Rise Too High

Another way to ensure that money keeps flowing into your practice is to catch denials before they pile up, Gidwani says. “Make sure that the percentage of claims denied on first submission is five percent or less,” he notes. “The cost to follow up denied claims is very high, which increases billing costs and negatively impacts the bottom line.”

In addition, when a patient calls regarding a bill, use the conversation as an opportunity to collect from the patient, he adds. Spend as much time as necessary to explain the bill to the patient, and answer the patient’s questions methodically and patiently. You don’t want to miss the opportunity to collect outstanding balances due from the patient.

“In summary, there are no ‘short cuts’ in the medical billing process, nor does one need ‘magic’ in their hands to collect dollars efficiently,” says Gidwani, who offers more information on medcurrence.com. “Being diligent, thorough, knowledgeable, compliant and pro-active throughout the process will always bring positive results.”