Five industry professionals weigh in on the best ways to improve coding and billing practices.
Taylor Moorehead, regional partner for Zotec Partners and corporate compliance officer:
"Try to get better contracts, review all of them and see who is out of line and what you can do about it. Try to unbundle all of the bundling that [The Center for Medicare & Medicaid Services] has done by carrier; this can be very lucrative.
Get all of the patient's portion up front. If they can't pay, use a service to charge their credit card every month or checking account. Reduction in bad debt as the number of Health Savings Accounts rise
Understand your costs and what it truly costs you to provide a service. Knowing this will help you remove services that cost you money. If you understand your costs, then you can negotiate rates for volume and everyone is a winner."
Sunni Patterson, president and CEO of RMK Holdings and co-founder of Medical Bill & Claim Resolution:
"Statistics show that medical practices never collect on 18 percent of their claims due to their lack of resubmitting claims that were denied on the first pass. In addition, it is estimated that providers are underpaid by an average of between 7 percent and 11 percent on claims that they do submit, mainly due to medical coding errors.
My best tip for billing professionals to collect this lost revenue is to improve, upgrade and automate the practice’s revenue cycle management system. New technologies like EHR and practice management systems can be used to do this. One of the most effective actions to take and one that speaks directly to the statistics related above is to implement a potent rules engine, one that will not only check for the proper coding but automatically identify the claims most likely to be denied."
Stephen Price, owner of payment processing company E-Complish:
"Our latest tip we have been giving billers is to start adding a QR code to the bills that customers receive in the mail. This enables customers to scan the QR code using their smartphone, which directs them straight to the online bill-payment sites, which allow payments to be made on a standard website or mobile site. This lets them pay their bills right then and there, through their smart phone.
Our clients have been absolutely loving this … It gets them paid more quickly and easily, and for the customers, they don't need to stress about the bills and wait to pay them at a later time. It's pretty much win-win, and doesn't require any specific Mobile apps for payment, just a smartphone with a QR code reader."
Dan Rodrigues, CEO of medical office software maker Kareo:
"Practices can make or break the entire revenue cycle based upon one single factor — the patient's eligibility for medical coverage. There are several key steps practices can take to make sure they get paid in a timely fashion and the amounts owned. First, leverage technology to automatically check the patient's eligibility. Most major insurance plans provide an electronic verification of coverage and leading medical billing software make this step as simple as a mouse click.
Second, evaluate the level of coverage the patient has. Often, preventive care services are covered 100 percent by plans. On the other hand, specific procedures, imaging studies, or pre-natal services may be partially covered and sometimes not covered at all. Thirdly, understand the patient's out-of-pocket responsibility. With today's high deductible plans, it is common that the majority of routine care is actually paid by the patient and not the insurance company. Patients are likely to have a co-pay and co-insurance responsibility as well.
The critical point for practices is to know where the payments are coming from. If a majority of the money will be from insurance reimbursements, then practice staff can take actions to submit claims quickly. If a majority of the money will be paid by the patient, then payment collection directly from the patient can occur before the services are rendered. The bottom-line: Checking eligibility helps avoid wasteful, costly missteps in the payment collection process and gets the practice paid for services quickly."
Andy Salmen, director of business development at Healthcare Information Services:
"Experience and expertise is key. One of the most important steps a practice or ASC can take to ensure improved billing and revenue is either hire or partner with experts in their specific field. To have an efficient and effective management of the practice's reimbursement, it is imperative that experienced professionals are an integral part of the revenue cycle.
Look for professionals or organizations that have a proven track record within your specific specialty [such as] orthopedics or ASC. In addition, certified professional coders are an absolute must. These highly skilled and educated professionals have had extensive experience in the industry and specifically trained to ensure proper coding. Having certified professional coders involved in the management of your revenue cycle will accomplish at a minimum two things — capture all charges ensuring there is not any loss revenue and maintain compliance."
Taylor Moorehead, regional partner for Zotec Partners and corporate compliance officer:
"Try to get better contracts, review all of them and see who is out of line and what you can do about it. Try to unbundle all of the bundling that [The Center for Medicare & Medicaid Services] has done by carrier; this can be very lucrative.
Get all of the patient's portion up front. If they can't pay, use a service to charge their credit card every month or checking account. Reduction in bad debt as the number of Health Savings Accounts rise
Understand your costs and what it truly costs you to provide a service. Knowing this will help you remove services that cost you money. If you understand your costs, then you can negotiate rates for volume and everyone is a winner."
Sunni Patterson, president and CEO of RMK Holdings and co-founder of Medical Bill & Claim Resolution:
"Statistics show that medical practices never collect on 18 percent of their claims due to their lack of resubmitting claims that were denied on the first pass. In addition, it is estimated that providers are underpaid by an average of between 7 percent and 11 percent on claims that they do submit, mainly due to medical coding errors.
My best tip for billing professionals to collect this lost revenue is to improve, upgrade and automate the practice’s revenue cycle management system. New technologies like EHR and practice management systems can be used to do this. One of the most effective actions to take and one that speaks directly to the statistics related above is to implement a potent rules engine, one that will not only check for the proper coding but automatically identify the claims most likely to be denied."
Stephen Price, owner of payment processing company E-Complish:
"Our latest tip we have been giving billers is to start adding a QR code to the bills that customers receive in the mail. This enables customers to scan the QR code using their smartphone, which directs them straight to the online bill-payment sites, which allow payments to be made on a standard website or mobile site. This lets them pay their bills right then and there, through their smart phone.
Our clients have been absolutely loving this … It gets them paid more quickly and easily, and for the customers, they don't need to stress about the bills and wait to pay them at a later time. It's pretty much win-win, and doesn't require any specific Mobile apps for payment, just a smartphone with a QR code reader."
Dan Rodrigues, CEO of medical office software maker Kareo:
"Practices can make or break the entire revenue cycle based upon one single factor — the patient's eligibility for medical coverage. There are several key steps practices can take to make sure they get paid in a timely fashion and the amounts owned. First, leverage technology to automatically check the patient's eligibility. Most major insurance plans provide an electronic verification of coverage and leading medical billing software make this step as simple as a mouse click.
Second, evaluate the level of coverage the patient has. Often, preventive care services are covered 100 percent by plans. On the other hand, specific procedures, imaging studies, or pre-natal services may be partially covered and sometimes not covered at all. Thirdly, understand the patient's out-of-pocket responsibility. With today's high deductible plans, it is common that the majority of routine care is actually paid by the patient and not the insurance company. Patients are likely to have a co-pay and co-insurance responsibility as well.
The critical point for practices is to know where the payments are coming from. If a majority of the money will be from insurance reimbursements, then practice staff can take actions to submit claims quickly. If a majority of the money will be paid by the patient, then payment collection directly from the patient can occur before the services are rendered. The bottom-line: Checking eligibility helps avoid wasteful, costly missteps in the payment collection process and gets the practice paid for services quickly."
Andy Salmen, director of business development at Healthcare Information Services:
"Experience and expertise is key. One of the most important steps a practice or ASC can take to ensure improved billing and revenue is either hire or partner with experts in their specific field. To have an efficient and effective management of the practice's reimbursement, it is imperative that experienced professionals are an integral part of the revenue cycle.
Look for professionals or organizations that have a proven track record within your specific specialty [such as] orthopedics or ASC. In addition, certified professional coders are an absolute must. These highly skilled and educated professionals have had extensive experience in the industry and specifically trained to ensure proper coding. Having certified professional coders involved in the management of your revenue cycle will accomplish at a minimum two things — capture all charges ensuring there is not any loss revenue and maintain compliance."