Billing can be a frustrating part of physicians’ practices at a time when reimbursement is declining and administrative burdens are increasing on physicians and hospital systems. Adrian Velasquez, Wisconsin based co-founder and CEO of Fi-Med, a predictive analytics provider that aims to help physicians and medical systems improve cash flow and reduce compliance risk, has tips for finding common billing mistakes that cost a practice revenue.
“We’ve found that a lot of the declines in revenue are as a result of errors in billing,” he says.
These errors in billing occur for numerous reasons, ranging from “mergers and acquisitions with health plans and hospital systems” to attempting to adjudicate claims across state lines, when a medical system has hospitals or practices in two bordering states.
Here are some key tips for preventing billing errors:
Keep up on your codes
Every year the diagnosis codes change, which can lead to immense confusion and rejection of claims, Velasquez explains. The transition to ICD-10 codes added 55,000 new codes, he says, “and increased the complexity of coding, which increased denials and rejections.”
Rejections cost a practice money. He says that it costs an average of $6.50 to file a claim, $25 to resubmit a rejected claim, and $37 to correct and resubmit a denied claim. “CMS state that 60 percent of denied, lost or ignored claims will never be paid in full.”
As an example of how complex coding change can be, he gives an example of a change in a Medi-Cal code for anti-natal screening of a new mother. As of October 2017, the old code of Z36 could no longer be used, and the new code was Z36.87. “So we submitted claims that had the new code at the end of October that were denied because they weren’t in the system. And when we sent the old code, it was denied because it was outdated.”
To stay on top of coding problems, he recommends physicians “have someone on staff doing your coding, a certified coder, or outsource that coding. And make sure the physician’s documentation supports the codes that were used in the treatment of service.” Many times, he says, a claim is denied because the payer says documentation does not support it.
Add data analytics
Data analytics related to billing can help physicians identify areas of revenue loss and help put strategies into place “so you can proactively deal with those issues on the front end,” he says.
While some electronic health records or practice management software have analytics processes embedded, he recommends adding something in addition that a physician can customize to analyze denials.
He is fond of tools that can group denials together “so you can see the patterns” and allow a practice to correct these errors.
Fix common denial problems
A lot of denials can be easily fixed, such as denials that have to do with things like credentialing, “Where the provider wasn’t credentialed properly” as well as getting correct information from patients.
At the point the patient enters into the practice, he recommends there be someone doing an automatic eligibility verification—an easy software to add to an EHR—identifying their benefits and the amount of their deductibles that is left.
“If you don’t do this on the front end, you will probably not get the payment on the back end.” He makes the case that dentists have been doing this “for years.”
He also urges physicians to make sure their administrative staff is sending out claims as close to the date of service as possible. “Do not delay or wait. When your claims are paid, look at your denials with a tool where you can run reports and then aggregate them. Don’t work these claims one at a time.”
Don’t chase payments
Velasquez says that research has shown that patients who don’t pay their bills after the first statement are not likely to pay it after two, four or more bills. The same applies to sending patients to collections—it doesn’t work. “You really need to cut your losses and do a cost accounting analysis of all your payers and their reimbursements, as well as a cost analysis of your procedure codes, in terms of where do you lose money.”
He says that healthcare has become big business, which, while unfortunate is the way things have changed. In dealing with these changes, he suggests physicians remember “technology is a solution.”
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Photo courtesy of: Medical Coding News
Originally Published On: Modern Medicine
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