San Francisco Health Care Providers,
You’ve seen the iPhone commercial —
“Want to find the hot new restaurant on Market St.? There’s an App for that.”
“Want to find out how many calories you consumed at Pier 39 today? There’s an App for that.”
Well, there’s something you should think every time you provide a service for a patient- “There’s a CODE for that!”
Ever follow up with your patient over the phone? There’s a code for that.
Ever provide your patient with printed instructions for an at-home exercise routine? There’s a code for that.
Don’t sell yourself short- you may be providing more services than you know, and you should get paid for them…or at least try. In a world in which insurance carriers are pulling out all stops to minimize payments, you should be pulling out all the stops to increase them!
As someone who has seen the health care field from all sides (Billing Co. Owner, Office Manager, Medical Assistant, Patient), I am continually taken aback by the amount of money which goes uncollected for uncoded and unbilled services! I often also see situations in which a doctor provides a service and codes for it, but is completely unaware if the code ever got paid, how much the insurance company allowed for it, or even what the reimbursement amount was if it did get paid (yes, this can and does differ). Ignorance in this situation may be bliss, but it’s downright expensive bliss!
Fortunately, with some persistence, time, and research you can take control of the situation and turn it to your favor! Follow these steps, or better yet, delegate them to one of your staff and after a few short months you’ll notice your collections steadily increasing. The process I outline below can be undertaken over the course of 2 weeks or 2 months. But the important thing is that it happen.
STEP 1: Create a list of every piece of medical equipment in your office- include everything, no matter how common place – from massagers to instructional pamphlets to pharmaceutical samples. These are the resources you employ in the provision of your services and you should put them to productive use when possible. Also include on this list the services you’re currently providing and their codes. I recommend using an Excel document to keep the process organized and systematic. Create one spreadsheet for the contracting insurance companies and another for non-contracting companies.
STEP 2: If you don’t the specific code for each service you provide, pull out your dusty old code book and look it up. And if it is dusty or you don’t own a CPT code book, BUY ONE NOW and buy a new one EVERY YEAR! DO NOT rely on search engines such as Google to find codes – not only is this time consuming, but these codes are often out of date. As I mentioned previously, insurance carriers and government programs derive an economic benefit when you submit the wrong code. An up-to-date code book is worth its weight in gold. And when you’re looking up codes, don’t forget to document modifiers such as “time units”, should they apply – such as with certain manual procedures or E&M’s. You don’t want to miss out on potential reimbursements, but you also don’t want to submit a code which turns out be fraudulent.
STEP 3: Now that you’ve documented all the services you provide along with the appropriate codes, the next step is to document the associated reimbursements. If you are contracting with insurance companies, simply contact them. If there’s a long list, you may want to have your staff call in over the course of a week. You should also research the company website, as some companies have a published fee schedule.
Getting reimbursement rates from insurance companies with which you don’t contract, requires more effort. First, contact the insurance company and “verify” that a particular code is, in fact, on their fee schedule. If it is, ask them for the allowable amount. Most often, they won’t respond. Don’t get off the phone until you’ve asked three or four times- most people give up after the initial roadblock, and this is what the “bank” on. If after pressing the issue, they don’t provide you with an answer, your only recourse is to provide the service as needed and bill for it. Once the EOB come back you’ll have the answer you’re looking for and it will pay dividends in the years to come- think of this process as investment.
As you implement this plan, your excel spreadsheets should look similar to this:
You can keep an insurance “bible” that contains this information in it and update it as you go along. Just keep filling in the blanks as your EOBs come in. Turn the process into a competition and reward your staff as they identify codes and reimbursement amounts.
As you make progress on your list with new information, print out a copy and laminate it. Keep a copy at the front desk as a reference so both you and your staff will always know what codes are paid by what insurance companies. Before you know it, everyone in your office will be more focused on making sure all the services you provide get CODED AND PAID!
The key to success in this endeavor is to focus on the PROCESS.