More on Reimbursement

Providers and billing departments face possible communications gap

Technology can improve internal communications to maximize reimbursement and avoid billing errors.

Jeff Lagasse, Associate Editor

Healthcare providers may not be fully aware of reimbursement claims processes, and that can lead to less-than-stellar communication between providers and billing departments -- though there are steps that can be taken to curb this trend.

A survey conducted by the Center for Healthcare Leadership and Management revealed that 42% of physician assistants don't know whether claims are billed under their own name and 20% of nurse practitioners are in the same boat. And the same percentage in each group weren't aware of whether claims were billed under their own national provider identification number, the physician's NPI or a combination.


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Culling responses from 3,450 physician assistants and 250 nurse practitioners, the data suggests a communications gap that can make it difficult to maximize reimbursement, increase revenue and avoid billing errors.

One finding was that physician assistants are less likely than NPs to bill under their own NPI, perhaps because many commercial payers don't authorize physician assistants to do so. While 55% of NPs submit claims under own number, only 34% of PAs do the same.

More than half of all respondents, 57%, said their compensation was not based on billing, collections or other productivity measures such as relative value units. A similar number said they were unaware of any technology solution or process that tracked productivity data or quality metrics such as rates of hospital-acquired infections.

Eighty-seven percent of respondents said they'd received education on coding and documentation, while more than 70% said their employer provides documentation feedback.


Technology may be one of the keys to improving not only internal communications about claims, but the results of the claims themselves.

A high rate of claims denials makes it difficult for any organization to maximize revenue, but providers can curb denials by pre-determining eligibility and practicing time-of-service collections.

Twitter: @JELagasse

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