Podiatry Coding & Billing Alert

A tight economy coupled with an electronic health record imperative means that medical practices are under more pressure than ever to collect every cent available to them. Follow these three tips to refine billing procedures and get more results -- with less effort.

1. Review financial measurements. You may think your accounts receivable (A/R) department is running at 100 percent efficiency, but when is the last time you reviewed the processes? When Medicare pay appears poised to drop, practices try to immediately focus on improving their A/R, but this should be an ongoing goal, says David J. Zetter, PHR, CHCC, CHCO, CPC, CPCH, PCS, FCS, CHBC, with Zetter Healthcare Management Consultants.

"There are always situations like these that bring about a better financial focus on the business when the impact is great or immediate, but it may be too late for some because they have a reactive nature rather than being proactive," Zetter says.

Businesses should have processes in place to consistently review financial measurements to ensure the business is running efficiently and successfully, Zetter says. It also provides specific measurements and feedback to employees.

2. Track the status of submitted claims. Following up on your submitted claims early in the game can save you time.

"We submit claims electronically. First of all, I ensure that once [claims] are submitted that they are accepted," shares Tara Homan, senior biller with Alpha Medical Billing Associates in Lima, Ohio. If the claim is rejected, the first order of business is to research why. "Catching it in the initial submission phases ... saves you the average 30-45 day wait for insurance to deny it," she says.

Reasons for denial may be "an invalid diagnosis or CPT code (which I update each October and January with new updates) or a policy termination," Homan says. If the latter is the case, Alpha Medical bills the patient with a note on the statement to call immediately with updated information.

Calendar it: Try placing an event reminder on your Outlook or Web calendar every week that reminds you to check all accounts receivable for the past 30 days, suggests Homan. Print that report, and go online or call to check claim statuses.

Fastest way: "I try to do everything online as it is much quicker than waiting on hold for a customer service representative to answer your question," Homan says.

3. Determine whether an outsourced billing company is earning its fees. "A billing company that isn't catching every penny, even if it's charging you a smaller percentage in fees, can ultimately be more expensive than a billing company that charges more but is collecting more," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions. "You have to think about what it costs to collect that money," Cobuzzi says. "If a billing company (or your internal billing department) keeps your revenue where it is or increases your revenue rather than your income falling, they are a profit center and not a cost center."

Don't overuse collection agencies. After sending a second statement, call the patients to ensure receipt and inquire if they'd like to set up payment arrangements. "As long the patient is making a monthly payment, we never turn them over to collections," Homan says. If the patient makes no attempt to pay, then Alpha Medical asks the physician for approval to send the bill to a collection agency.

4. Know your practice benchmarks. If you are aware of your average number of days in A/R, then you'll be able to notice immediately if that number rises, rather than wondering whether it has gone up or down.

An average number of days in A/R can be different for every business "depending on the payer/patient mix and the contracts they have with them," Zetter says. "It is difficult today to have a business in the medical industry and be successful if you don't have a plan and constantly monitor the business based on specific measurements to benchmark against. Those that do are successful and will usually continue to be."