Wiki RE: Billing/Coding Pediatrics-being organized

[Kar116]

RE: Billing/Coding Pediatrics-being organized

Hi everyone,
I am a new biller/coder for a pediatrics office since October 2012. The office I work for has had claims dating back to 2011 that had not been followed up properly so I am having to send out letter of appeals to insurance companies. My question to you all is can you give me some hints on how to multi-task? I am jumping from the aging list to the old aging list back to denied claims then to the letters and staying on top of billing postings. I am the only biller as one of the medical assistants is unable to help with billing because of patient care right now. This is a private practice with only 4 of us, 1 doctor, 2 MA's and me the biller. There are about 200 patients so this is why they finally hired a biller. Any ideas out there for me? HELP!

Thanks.

 

[amar1727]

Regarding the old 2011 claims; I would first make sure they are within the time limit for appeals. Carriers have deadlines for filing and for appealing claims. Then I would work the aging report for claims, in the over 120 day bucket. Depending on if they were billed and denied or never billed. If they were never billed, bill them all. If they were denied, pull the EOMB to inquire if it's a quick error that you can correct by pulling the chart, dob wrong or invalid insurance ID #. Then after getting all of that done then keep it all as current as possible, along with daily billing of charges and weekly posting of payments/denials received.

Ani Marrero, CPC, CPC-H, CPC-I
Unique Career Academy for Medical Billing & Coding

 

[Pam Warren]

I'd first prioritize your work.

Absolutely keep up with your new AR...payment posting, denials, self-pay (make sure you're collecting copay at the time of visit), so that you don't create more problems for yourself as time goes on. This is your first priority.

As far as the old AR, I'd look at only those visits where you have significant balances. It's not worth going back to try to get $20.00.

Then look at your higher balances, by payer, depending on their filing limits. Work the ones that are not over the filing limit (OFL) first and then the ones OFL that will will require just a letter, to get those off your plate. Denials should be worked by balance, and also gone through to see if you should transfer the balance to the patient. It's not cost effective to expend a lot of energy on your lower balances.

Self-pay balances will require a statement, followed up by a letter or even better, a call. And if patients are current, have statements ready when they come in so you can address their old balances face-to-face.

As the money comes in, keep track of your reduced days in AR, the percentage of AR you've collected, and the days in AR from the time you were hired. This is the kind of stuff you present when it's time for a raise!!

As you move forward, it would make sense to create a billing/financial policy.

 

[Cynthia Hughes]

I agree with all that has been posted so far. In addition, look for repeated errors in coding that may allow you to identify that all claims containing specific codes that need correction and resubmission. Then be sure that new charges are being reported with the correct codes.

If there is substantial revenue that appears to be collectable but is nearing timely filing or appeals deadlines, it may benefit the practice to bring in a temporary employee experienced in accounts receivable to help bring the accounts up-to-date. The cost versus benefit analysis should take into account the potential for using this time to put in place resources, workflow, and practice policies that will decrease day in A/R in the future.

In a small practice, even the small losses add up quickly.

Good luck,
Cindy