Here are five best practices for managing claims at orthopedic and spine groups.
1. Claims management should be trusted to trained employees. Orthopedic surgeons often leave their billing and revenue cycle management to lower skill level employees, trusting them to accurately bill for services rendered. Unfortunately, such employees often are not educated about the best practices for billing and coding, and y may be leaving money on the table by submitting inaccurately coded claims or failing to go after denied claims.
"The education and skill set of the person who is controlling the revenue is huge, and these people must stay on top of industry changes," says Nancy Moore, president of NBP, a practice management support company. "We regularly see practices where 30 percent of their accounts receivable is lost money due to inaction "
2. Make sure staff enters patient information correctly. When the person who schedules the appointment enters patient information into the system, it is a recipe for multiple errors, says David Wold, CEO of Healthcare Information Services in Park Ridge, Ill. That's because the appointment scheduler has other functions to deal with and may not have the time, focus and understanding to make sure each bit of data is correct. There are fewer errors when the patient is handed off to the business office, and the business office enters the information. If this is not possible, then the business office should at least double-check the information.
3. Conduct chart audits for accurate coding. Audit the medical charts to ensure the surgeons are capturing all the codes possible and correctly describing or coding the services rendered. The surgeon needs to know every different step of the treatment that is billable and how to describe the treatment accurately to receive the highest amount of compensation. "Make sure the physicians are getting paid for the amount of time they are spending with the patient," says Michael Franks of Physician Business Services in Tampa, Fla., a company that partners with physicians to handle back office and administrative responsibilities for more than 50 physician practices. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
4. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Monty Miller, president and co-founder of Momentum Billing. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.
5. Have a process in place for denied claims. When claims are denied, orthopedic practice staff should know exactly how to deal with them. Have a process in place to locate the mistake, fix the error and then have the claim back out the door quickly so denials don't bump against filing deadlines. "In some cases, when practices receive a denial there is no activity on it because the practice hasn't staffed someone to take responsibility for denied claims," says Dave D'Silva, COO at Healthcare Information Services, a company focused on maximizing physicians' reimbursement and revenue. "You're leaving money on the table by not fixing or appealing these claims."
Incentivize your employees to meet national benchmarks. If the staff still has trouble, you might want to consider outsourcing denied claims to achieve the best returns.
Related Articles on Orthopedic Practices:
10 Ways to Differentiate Sports Medicine Practices in a Competitive Market
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11 Statistics on Orthopedic Surgeon Practice Setting
1. Claims management should be trusted to trained employees. Orthopedic surgeons often leave their billing and revenue cycle management to lower skill level employees, trusting them to accurately bill for services rendered. Unfortunately, such employees often are not educated about the best practices for billing and coding, and y may be leaving money on the table by submitting inaccurately coded claims or failing to go after denied claims.
"The education and skill set of the person who is controlling the revenue is huge, and these people must stay on top of industry changes," says Nancy Moore, president of NBP, a practice management support company. "We regularly see practices where 30 percent of their accounts receivable is lost money due to inaction "
2. Make sure staff enters patient information correctly. When the person who schedules the appointment enters patient information into the system, it is a recipe for multiple errors, says David Wold, CEO of Healthcare Information Services in Park Ridge, Ill. That's because the appointment scheduler has other functions to deal with and may not have the time, focus and understanding to make sure each bit of data is correct. There are fewer errors when the patient is handed off to the business office, and the business office enters the information. If this is not possible, then the business office should at least double-check the information.
3. Conduct chart audits for accurate coding. Audit the medical charts to ensure the surgeons are capturing all the codes possible and correctly describing or coding the services rendered. The surgeon needs to know every different step of the treatment that is billable and how to describe the treatment accurately to receive the highest amount of compensation. "Make sure the physicians are getting paid for the amount of time they are spending with the patient," says Michael Franks of Physician Business Services in Tampa, Fla., a company that partners with physicians to handle back office and administrative responsibilities for more than 50 physician practices. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
4. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Monty Miller, president and co-founder of Momentum Billing. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.
5. Have a process in place for denied claims. When claims are denied, orthopedic practice staff should know exactly how to deal with them. Have a process in place to locate the mistake, fix the error and then have the claim back out the door quickly so denials don't bump against filing deadlines. "In some cases, when practices receive a denial there is no activity on it because the practice hasn't staffed someone to take responsibility for denied claims," says Dave D'Silva, COO at Healthcare Information Services, a company focused on maximizing physicians' reimbursement and revenue. "You're leaving money on the table by not fixing or appealing these claims."
Incentivize your employees to meet national benchmarks. If the staff still has trouble, you might want to consider outsourcing denied claims to achieve the best returns.
Related Articles on Orthopedic Practices:
10 Ways to Differentiate Sports Medicine Practices in a Competitive Market
10 Tips for Online Orthopedic Practice Marketing
11 Statistics on Orthopedic Surgeon Practice Setting