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5 headaches to avoid in billing

One of the biggest challenges hospitals face is getting paid

One of the biggest challenges hospitals face is getting paid. There’s a long list of headaches contributing to a very challenging landscape in the medical billing world.

Michele Hilton, general manager of medical billing services, ADP AdvancedMD, can say she’s experienced all the headaches associated with medical billing. Here, she offers a little painkiller cocktail to preemptively strike against the headaches of medical billing.

[See also: AHA endorses updated patient billing, collection procedures]

1. Not using electronic insurance coverage verification: Any practice that has not adopted technology to help them automatically check patient eligibility prior to an office visit is losing out said Hilton. From one month to the next, hospitals and private practices can be sure some percentage of its patient population has lost a job and health insurance coverage or changed jobs or changed insurance provider. If the front office isn’t updating patient demographics with the latest eligibility information, revenue could be at risk.

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2. Not collecting 100 percent of the copays and a reasonable “down payment” on patient portion: Many medical offices do not enforce best practices for collecting patient portions. Having a clear policy where the front desk person asks for a credit card to capture the patient copay during check-in, Hilton said, can be very beneficial. Next, front office administrators should be asking patients for a down payment on top of the deductible – especially if the visit takes place during the first six months of the year. Depending on the visit type, Hilton recommends asking for between $50 to $100 down. She also recommends that clients select a merchant account service that is integrated with their practice management system, enabling a more secure, automated approach to collecting these payments.

3. Certain medical procedures are not covered under the patient’s plan: While the patient may have insurance coverage, plan carve-outs are on the rise, according to Hilton. Pre-determination of procedures covered is becoming essential for those specialties that perform high-cost procedures. More and more employers, in an effort to manage their medical costs, are selecting plans with reduced procedure coverage. If the plan does not cover those procedures, the patient is liable. Hilton recommends checking with plans prior to the visit to determine if those procedures are covered for the patient’s condition. And if these procedures are not covered, the practice should offer a payment plan to their client at the time of check-in.

4. Certain medical procedures require pre-authorization prior to service delivery: Many plans won’t reimburse for certain procedures unless the procedures have been pre-authorized by the plan. Hilton recommends to clients that they take inventory of all the procedures they perform that require pre-authorizations and keep track of which plans require this step. Track this on a spreadsheet. Review upcoming patient visits for these procedures and get authorization. She also recommends using color codes to keep track of visit types so they are easy to see prior to the date of the visit.

5. Lagging behind in coding and missing out on potential revenue: Many practices fall behind in using the newest codes for procedures they perform. These newer codes often offer higher reimbursement options. Hilton suggests reviewing charge slips at least once a quarter. Attending the training session on coding at annual specialty conferences is highly beneficial. Another option is to take top CPT codes billed and source them against the latest CPT manual.