Pulmonology Coding Alert

Determine whether you’re missing these sources of cash in your practice.

Many pulmonology practices are just ramping back up their patient visits following several months of office closures prompted by COVID-19. This has not only caused some patient appointment backlogs, but has prompted serious cash flow issues.

To ensure that you aren’t overlooking any hidden sources of cash, we sat down with Adelaida Samuels, CMC, CMBSI, CEO of Medical Billing & Consulting Solutions in Rochester, New York, who provided the following tips on how to boost your cash flow.

1. Add Steps Between Billing and Collecting. “Often, I’ll go into a practice and ask the biller their process and they’ll say they submit claims and post payments. But there’s so much in between,” Samuels says. Make sure your practice is taking the steps necessary to answer every question that may arise during the claims process.

“Are you scrubbing the claim before you submit, making sure you catch any edits?” Samuels asks. “Are you working edits used by the clearinghouse? Are you making sure the claim is as clean as possible when it goes to insurance? Are you reviewing acknowledgement reports from the clearinghouse? When you post the payment, are you working your denials? Practices are definitely losing money by missing these steps.”

2. Always Scrub Claims. The term “claims scrubbing” refers to the art of checking your claims for errors and omissions that could lead to denials or underpayments. And many practices seem to be missing this step, Samuels says.

“Let’s say the patient had a urinalysis, but the physician only charges an E/M on the claim,” Samuels says. “How will the biller know the urinalysis was left off the claim? That’s all part of scrubbing the claim and looking at the diagnosis. They don’t have to be coders, but they do need the knowledge to be able to review a claim and see a urinary tract infection and question if only an E/M was actually performed, particularly if your practice has a lab. You’d then look at the progress note and maybe you see a urine dip. You can’t add it but you can send it back and say, ‘Hey, I noticed a lab report for a urine dip and I didn’t see a urinalysis in the note.’”

3. Work With Trained Staff Members. Samuels says one of the biggest issues she sees at medical practices is that their billing staffs are not trained properly. “Maybe they hire billers who worked in a different position in the office, but they didn’t train them properly. Some offices think anyone can do billing, but it’s challenging, and they must be trained in the entire process of revenue cycle management.”

4. Include the Whole Team. Billers shouldn’t be the only people involved in the claims process. Samuels says. “Work with the whole team, front desk, coder if you have one, and providers,” she notes. “I tell billers they are back end, but if they have a good front end and the physicians are being educated on documentation and coding, all of this combined is the start of the billing process. Everyone should know enough to notice when something is not right with a claim.”

5. Regularly Run Aging Reports. To ensure that you don’t have claims that are sitting in a payer’s pipeline unpaid, you should run aging reports once a month. “Always go back over your accounts to see if money has come in,” Samuels says. “I always ask billers how often they work their aging — they’ll say when they can, or when they get around to it. But 85 percent of a biller’s job should be their aging.”

That’s because the actual claim submission process itself shouldn’t take very long at all once you get a good procedure going, so you should be working the invoices and checking on them frequently. “Have a goal that fewer than 10 percent of your claims should be in A/R for 120 days or more. That’s aggressive, but you may want to put a goal around getting to that. And it should never get to 20 percent. You don’t want 20 percent of your money sitting out there for over 120 days, especially right now.”

6. Get the Front Desk Involved. Don’t forget to ensure that your front office staff is maximizing revenue by checking eligibility before patients come in. Check ahead of time to see if patients have met their deductibles, Samuels says. “High deductibles are very common right now. If they haven’t met their deductible, call the patient ahead of time and tell them the amount they’ll be responsible for at the visit and why. Some practices say this is too much work — they’d rather just bill the patient. But this slows down revenue. Once you have them in the office, it’s easier to collect it.”