With the many pressures facing today's health care practitioners, running a physician practice or medical group business in the most efficient and profitable manner is an added challenge. Take, for example, the myriad of issues that can occur in any given day around medical billing.
It's likely that billing and coding missteps can cost a practice millions of dollars each year if errors go unchecked. What's more astonishing is that these errors are, in many cases, relatively avoidable.
According to the American Medical Billing Association, in a recent survey, nearly half of all claims were pended due to commonplace reasons like submission of duplicate claims, lack of complete information or other information needed to justify the claim or invalid codes. In addition, the survey results indicated 24 percent of pended claims were due to other routine questions around coverage issues, including no coverage based on date of service, non-covered or non-network benefit or service, coordination of benefits, or coverage determination.
How can these inaccuracies be avoided, and what's the best line of defense for these missteps? It's pretty simple and probably sitting right in front of you each and every day – your receptionist.
A practice's receptionist is not only the front face of the office. They're also, in many instances, the launch of a practice's revenue cycle. They're the person getting the patient name, insurance provider information and sometimes, the same individual processing the claim, assuring codes and modifiers are accurate, and checking and re-checking before submission. If proper training, resources and ongoing support aren't provided to a receptionist, however, a spiral of mistakes will accumulate, and soon the problem becomes an epidemic. Many times, these denied claims fall into billing limbo, and eventually get written off, sometimes without the practice's physicians ever knowing the final outcome of payment.
And the job of receptionists, practice managers and others running the business side of a practice will get even more complicated soon, due to the approaching ICD 10 transition next year, when medical coding options will grow exponentially, unfortunately also increasing the likelihood of error.
So what can a practice do? Along with assuring your receptionist is trained, informed and has appropriate resources and tools at their disposal, here are some additional tips to consider:
- Appoint a practice administrator who is also trained and updated on code, modifiers and your revenue cycle. They should be working in tandem with your receptionist, assuring that front-line information is correctly retrieved, stored and checked.
- Assess your current billing practice to make sure it's updated and optimized.
- Prepare for ICD 10 transition now. Training, resources and appropriate tools need to be in place before the October 2014 deadline. Don't procrastinate.
- Consider engaging a third-party consultant to help with assessing your practice billing systems and improving procedures. You may not be able to make these adjustments on your own. Sometimes, an outside professional can see deficiencies better than you can, with an objective and independent eye.
Keep in mind, simple improvements can net big results. Common scenarios of this are included below:
- A new practice management system was installed and calibrated incorrectly for a practice. In addition, incorrect drug codes were being entered. After uncovering the errors, a simple modification and the fix generated $300,000 that otherwise would have been lost.
- A practice found they were not receiving payment for a certain chemotherapy drug. Through research they found the drug had been coded improperly in filing through their clearinghouse. This was fixed and the claims were paid, resulting in nearly $100,000 for the practice.
- It's not uncommon to see simple mistakes due to coding issues or incorrect information, like wrong date-of-birth or name misspellings, once corrected, result in payment of $10,000 or more.