Alliance Medibilling CEO Annette Bolcato has 25 years of coding and billing related experience. She spoke with Becker's ASC Review about the challenges industry professionals face and how outsourcing services can help physicians avoid worrying about payer issues.
Note: Responses have been edited for length and clarity.
Question: What are the main advantages of outsourcing medical billing and coding?
Annette Bolcato: Practices get to focus more on care and patient satisfaction. A lot of times, with medical billing and coding in-house, it makes it difficult for the physicians to concentrate on their job. We have certified coders and billers that make sure claims go out as clean-claims as opposed to something that's going to be rejected, because things missing will delay [providers'] time. We help them out with trying to maximize reimbursements.
We do a lot more than medical billing. We like to do consulting, we like to go in and be able to help audit. We'll do an analysis of what's going on.
Q: What are some reservations practices have about outsourcing their medical coding and billing?
AB: Most practices they feel like they're losing a little bit of control. They have that feeling of, 'Can we trust this company?' A lot of them are very used to having their biller in-house, but the biller they might have is not up-to-date on all the changes so they might be losing revenue because they might be using codes from a long time ago.
Q: How do you address those concerns?
AB: We let them know that they're outsourcing, but we're just an extension of their office. We also provide our clients with a monthly breakdown of their cash flow, showing what physician is billing what charges. We make it very personal to them, which I think is really important. We assign one to two certified coders to their account. [If they have questions,] we're not going to make them talk to four different people. We send out a monthly publication to our clients, so if we have any changes that come up during that month for their specialty, we include that. We let them know anything we know.
Q: How do you keep up to speed with changes to the coding system? And how will you handle changes that come with ICD-11?
AB: Constant continuing education. Everyone here is certified. Everyone is taking continuing education classes all the time. If something is new, we're getting new publications, we're getting the latest news on Medicare, we're going to seminars. We let the physicians' offices know that.
Q: Can you describe your annual audits?
AB: We do an annual audit [to] make sure for their geographical area they're getting paid what they should be. In other words, when we're getting EOBs from a certain insurance carrier showing we're getting 'X' amount of dollars, we show that this is what they're paying in that area. They will pay if they have proof we've received payment for that service in that geographical area. We let them know where we've gotten our information from, they'll review that claim, and 85 percent of time, they'll come back and actually give us a reimbursement on that.
Q: What are the biggest challenges medical practices face?
AB: Insufficient documentation is a very big issue. That is the most important key to coding and billing. There's a saying: 'If you didn't document it, it wasn't performed,' and that's very true. It has to be documented. I see it with most of our clients now. We can't stress enough how important it is, across the board. We're living in a world where everything you say has to be documented.
At least 80 to 85 percent of our denied claims are due to payers saying it's not 'medically necessary' because the documentation being provided by the office is not what they're looking for, for that specific procedure. There's a certain criteria we have to meet when claims go out. Everything [payers] look for has to be on there. We let the office know this is the criteria that needs to be met to bill those codes or they're not going to pay.