The following information is crucial to the success of any medical billing office. Doctors simply do not pay enough attention to the admission/information gathering process. Receiving maximum reimbursement for your procedures is important; however one mistake in any of the following nine areas could result in NO payment whatsoever!
The biggest mistake I have experienced in over 15 years as the owner of
a successful medical billing service, is the almost blind assumption by some
physicians that their office manager ,”walks on water” and that
billing staffers work hard and truly care about the practice. Assume the contrary
or at a minimum look upon your staff with guarded optimism and you'll make a
lot more money!
The second biggest mistake made by physicians is not taking a closer look at
exactly what is being written off and why!
1. Always
get a copy of the front and back of the patient's
insurance card even if they're
an existing patient. Never assume that just because
the patient is a repeat there is no need to look
at his/her insurance card. Patients change insurance
all the time. They also go in and out of coverage
all the time.
2. Ask
the patient if he/she is covered by any other
plan
3. Is
the injury related to work or other type of accident?
Many patients seeking pain management services
have multiple injuries and are being treated for
these injuries simultaneously. It is not uncommon
for pain management physicians to treat one part
of the body which is Worker's Comp. related and
another injury from an automobile accident which
is a completely separate and independent case.
4. Always
obtain a second form of ID such as a driver's
license from a patient. This
information is very important especially if later
on you experience collection problems. It's always
best to assume that you have future collection
problems especially with pain management.
5. Always
ask for the patient's work telephone number, cellular
phone, pager and a relative's telephone number.
This should be built into the encounter form.
If the patient leaves it blank your staff should
ask for additional phone numbers. This will also
play a crucial role in the collection process
later on. I cannot emphasize this fact enough.
Plan for future collection problems in pain management.
6. Always
obtain authorization when necessary!
Lack of authorization is probably the most commonly
missed element in the admission process and is
a real income killer. Insurance companies have
obviously made this very difficult on your staff
but if you want to get paid you need to get the
claims authorized. Insurance companies are particularly
notorious for denying," procedures"
when performed on the same day as a consult or
office visit. Many carriers expect a separate
authorization for procedures/injections above
and beyond authorization for an office visit.
Make sure your staff is familiar with which carriers
require separate and identifiable authorization
for procedures. Humana and Neighborhood Health
are both excellent examples of this.
7. Collect
co-pays and deductibles at the time of service.
8. Secure
sign Advanced Beneficiary Notice where indicated
9. Is the injury related to work or other type of accident?
Many patients seeking medical services especially
in the area of orthopedics and pain management have multiple injuries and are
being treated for their injuries simultaneously. It is not uncommon for physicians
to treat one part of the body which is work related and another from an automobile
accident which is a completely separate situation. Your encounter form should
have adequate fields for accident details.
I have yet to see a physician's medical billing office get this correct 100%
of the time. I have a pain management practice that saved over $100,000 last
year just by properly implementing step six
Written by David Duncan President and founder of Medi-Bill Inc.
www.usemedibill.com
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