Historically, when a patient with insurance came into a medical office, the staff obtained a copy of the insurance card and, if there was time, they made a call to the insurance company for eligibility status, benefits, and stop-loss information. Today, medical technology is all about networking with other systems in order to save time and increase billing success. Real-time eligibility increases staff efficiency and affords us the most accurate up-to-date patient data by performing payer inquiries online.
A medical business should always be making steps toward improvement. That is how we retain clients in all businesses. Have you ever thought, “Every worker is busy. The appointment calendar is full. The piles of work get bigger, but the money is shrinking. It feels like everything is out of control.”
These are common thoughts for many executives and employees when a business has grown to capacity. How can we find areas that need improvement? Self-audit is a tool that will help answer those questions.
Set aside a specific amount of time to work the denials received. The practice will be better off for this approach, because consistent data entry problems or billing errors can begin to show a pattern in poor workflow or training needs. Insurance companies also have time limits on adjusting and reviewing appealed claims, so time is of the essence.
When we receive a denial on a claim, we can use a logical approach to resolve the problem. Here are a few common reasons for denials and the steps toward resolution:
Secondary insurance plans often pay deductibles, co-pays, or coinsurance that is due after the primary insurance plan has paid on the claim. Secondary claims process through the insurer’s regular claims progression, so it may be somewhat of a surprise when a denial EOB shows up for a secondary claim.
Coding claims is tricky. Radiation oncology is especially difficult because of the planning and staging processes that occur prior to treatment. On a bad day a coder can create future problems that are difficult to remedy. Fortunately, Iridium Suite offers a safety net to help you avoid the pitfalls of improper coding.
After those payments come in from primary health insurers, it is imperative to have a reliable system for billing secondary insurers. Staying on track with sending secondary claims can be a challenge. Consider that using a manual process to bill secondary payers requires pulling patient charts, making copies of primary Explanations of Benefits(EOB), generating secondary claims, attaching all the required documentation together and mailing to the appropriate secondary payer.
Through the course of time, we have seen advancements in electronic claim submission, responses, and reimbursements. Now comes Electronic Health Records (EHR).
There are many patient collection styles in the medical industry, ranging from passive to extremely aggressive. The office attitude about collecting money from patients often reflects the physician’s own feelings about money and the empathy they have toward their patients. Patients usually understand that they will be paying for some or all of their medical care, but few will offer to pay the bill up front unless asked to do so.
In almost all businesses that carry accounts receivables, there is an ongoing, continual problem with slow-pay and non-pay customers. In the medical industry, accounts receivables include a variety of insurance agencies among the customer base. When the government is so heavily involved in mandating the payment process, which includes timeliness, one would think that the insurance claims aging would be much more current. But the problem doesn’t lie solely in the hands of the insurance companies.
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COMPATIBILITY IS THE NAME OF THE GAME IN INSURANCE BILLING
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