Practice Management Alert

Automatic claim crossover from Medicare to secondary insurers should be painless and produce fast payment. It rarely works, however, because Medicaid has unique coding and claim payment rules that are different from Medicare. To make sure that Hollingshead Eye Center in Boise, Idaho, a two-physician ophthalmology practice that includes an ambulatory surgery center, collects all of its payment, office manager Chris Felthauser has a comprehensive, step-by-step program that ensures fast submission of secondary claims and tracks follow-up on filed claims to verify that nothing is misplaced or lost.
Simple Steps Aid Tracking
 
 
When a Medicare payment is received, the billing staff posts the payment and photocopies the Medicare explanation of benefits (EOB). The EOB copies are placed in an accordion file by patient name so when the biller prints the HCFA 1500 Health Insurance Claim form to submit to the secondary insurer at the end of the day, the EOB copy that must be attached to the claim is at hand.
 
The time saver for us is photocopying the Medicare EOB when posting the payment, he says. You have to attach a copy of the EOB to the secondary claim, so copying it when its at hand saves time tracking it down later.
 
Most of my claims automatically crossover from Medicare to the secondary due to our billing system. But, sometimes Medicare has the wrong information regarding the patients secondary. My computer system identifies the secondary. This was a big feature when we looked for our system. Now, when we post from our Medicare EOBs, we know if theres a problem with secondary identification, and we file the claim manually, he says.

Examine Aging Report Every 30 Days  
Felthauser also runs the practices aging-accounts reports every 30 days, which he says is the best way to keep track of secondary claims that dont get paid.
 
If a crossover hasnt been paid in 30 days, we mail a hard-copy claim. Usually, our manually filed claims are paid within 30 days. If they arent, well be able to tell on the next A/R report we run, and we call to follow up and find out why, he says. With this system, Felthauser says he has no aging accounts over 60 days.
Get the Patient Involved  
Another approach to collecting on Medicare secondaries is to use the patients clout. At Esse Health, a multispecialty group of about 70 physicians in St. Louis, the practice bills secondary insurers only once, and then assigns the claim to patient responsibility if the insurer has not paid in 60 days.
 
The policy is communicated to patients in a variety of ways, says Gwendolyn Ousley, collection manager at Esse Health. We state our policy on our patient financial forms that are signed by the [...]