Urology Coding Alert

Our experts show you how 4 billing reports can help jump-start collections

You review your EOBs each month to pinpoint the causes of your denials, so you've done all you can to minimize future denials, right? Not so fast--the best medical office managers know you can't stop there. Monthly billing reports should be the second line of attack in denial management.

"Running reports and scrutinizing EOBs are the best ways to track denials," says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio. 

"Depending on the practice volume and personnel, bi-weekly and even weekly reports may be the way to go," Vogelberger says. The more often you run your reports, the faster you can catch carrier problems and correct them. "Sometimes a phone call to the insurer can correct the problem if it's something minor," Vogelberger says.

Get to Know 4 Monthly Reports

1. Aged trial balance by insurer. Most urology Coders are already familiar with an aged trial balance report (also known as an A/R aging summary) as a way to identify past-due accounts and unpaid claims.

But an aged trial balance is also a great place to start identifying denial trends that can indicate a billing problem in your office, says Anne Rowland, a billing consultant who works with three urology practices in Dallas.

Example: One of your physicians lets his Medicare credentialing expire. If you run an aged trial balance by insurer, you will start seeing a problem in the percentage of payments coming in from Medicare.

The total amounts in your 30-, 60- and 90-day unpaid-claims file will start to grow as aging continues. Once you discover this trend, you'll be able to uncover the root of the problem you're facing.

2. 120-day A/R report. When you run your monthly aged trial balance, you should also run a report of just the accounts that are 120 days or greater past due.

Go through this report and make sure you've worked on each account recently and that you already know the cause of the hold-up. Many times you will find a rogue account or two that has been overlooked and may represent a denied claim that you should appeal. 

Note: You could also do the same review of all accounts at 30, 45, 60 or 90 days.
 
3. Procedure analysis report. This report should include charges, payments and amounts that patients still owe on your most frequently billed procedures. If your office faces denials because you report a particular code inappropriately, this report will highlight the problem.

Example: If your practice still reports G0356 (Hormonal antineoplastic) for Lupron injections instead of the more current code 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic), your procedure analysis report will probably reveal continual denials for your Lupron injections.

The sooner you run the report, Rowland says, the sooner you can fix the problem and go back to those payers to let them know where you erred and to file a corrected claim.

4. Payer mix report. This report shows you the volume of revenue that you've collected from each payer. 
 
Formatting this report as a pie graph can help you to visualize your monthly norms and quickly spot any unexpected changes that may occur from one billing cycle to the next.

For instance, if Medicare normally makes up 35 percent of your monthly revenue and then suddenly Medicare drops to only 20 percent, you know to investigate to see if unresolved denials are the source of this change. 

The difference may simply be the result of a new patient mix, but it may also mean that your payer is not in sync with your claims submission process and that you should contact the insurer to determine whether you are submitting your claims properly.

Information Overlap Is OK

Bottom line: Don't turn your head on some of these reports because you think you may find an overlap of the data that the reports represent. The more information you have, the less likely you are to overlook a new or growing denial problem, and the faster you can correct it.

Each time you run your reports, put together a list of the problems you found and circulate it to the other members of your practice's staff.

Once You Identify Problems, Educate the Staff

If you don't have time for a formal meeting to discuss the problems that caused your denials, send an e-mail or newsletter to the rest of your staff detailing how to combat the problems going forward.

Not only will this help educate the rest of your practice but it will serve as a reminder of how you solved these problems, in case you ever encounter them again and need to remedy them.