Renovating a facility to accommodate the many spine procedures that can now be performed in outpatient settings often involves a digital makeover in the form of...
Surgery is perhaps unlike any other business in that you don't know if, how much or when you're going to be paid for your services.
"Yeah, that does have some truth to it," says Melody Rhodes, the biller and business office manager for the Castle SurgiCenter in Aurora, Ill. "You don't know the exact dollar and cent, but you can sort of guestimate it. This means you'd better have somebody really good in your billing department."
We're going to assume that you have a good sense of whether and how much you'll be paid. And that you're happy with your coder. What we're going to focus on is the when part - as in, how soon will the check arrive in the mail or electronically in your account? Courtesy of a few of your colleagues and a few coding and billing experts we consulted, here are 13 tips to help you get paid faster
1 Almost all of your billing should go out the door the next day
Your magic number is 24. As in, hours to bill every case after it's performed. Key to doing this: Condition your docs to dictate before they leave your facility for the day so that you can have the operative record the following morning
"The key to billing is to do it quickly and accurately and we cannot do this in an effective manner if all parties are not involved," says Sean A. Guetlein, MBA, the administrator of the San Angelo Ambulatory Surgery Center in San Angelo, Texas. "Besides convincing your docs to dictate that day's operative reports before they leave your center, you need to stress to them that you'll expect an immediate turnaround if you query them for any reason."
For Friday cases, consider having a coder-biller work half-days on Saturday from her home to get these cases billed in this window. "The $8 per hour I pay her is well worth it to me," says Mr. Guetlein.
Once you get your bill out within 24 hours after surgery, follow up with the carrier 15 days later to make sure it has gotten the claim, says Sharon Bowen, CASC, a vice president of operations with ASCOA in Savannah, Ga. "After that, we call them at 30 days and weekly after that," she says.
Yes, but how do you really, really get a claim out the door in 24 hours?
For Monica Ziegler, MSN, the administrator of the Physicians Surgical Center in Lebanon, Pa., the secret to billing within 24 hours is using a transcription service with quick turnaround and having several physicians use templates printed directly off the computer following the case.
And for Laurie Conradt, RN, the manager of the Aylward Surgical Center at Theda Clark Medical Center in Neenah, Wis., building an electronic medical records system will let her post charges immediately following completion of the case.
2 Do a mini audit before you send the claim out the door
What good is speed if you're not accurate? Key to submitting claims that are clean and complete is to check the little details that can hold up a claim if you're careless about them. It only takes a minute or two to avoid the most common errors that slow down your payments. For example, make sure you've got the correct ID numbers and that the CPT codes link with diagnosis codes properly, says Cristina Bentin, CCS-P, CPC-H, CMA, the president of Coding Compliance Management in Baton Rouge La. "Doing a mini audit on the front end can save time on the back end waiting to receive the rejection and then having to refile a claim," she says.
"Overall, it takes a strict attention to detail. I review every claim before it is sent out to verify its accurateness," says Kim Orwig, CPC, CPC-H, of the Indian Wells Valley Surgery Center in Ridgecrest, Calif. "Did I add the right codes? Did I remember that this insurance wants a number in this field? Accuracy is the key."
Another tip: Audit certain CPT codes up front to make sure they're correct and all ICD-9 codes support the documentation and the CPT code, says Andrea Hyatt, CASC, the administrator of the Dulaney Eye Institute in Towson, Md.
3 Verify insurance coverage
Lucy Zielinski, the vice president of business development with Medorizon, says that one of the most efficient ways to "extradite" timely reimbursement is to verify and pre-certify services. "So often, surgery centers are short-staffed and reluctant to spend time on the phone verifying coverage," says Ms. Zielinksi. She offers these tips:
- Develop a verification and precertification form and policy.
- Document the entire process, including whom your staff spoke with at the carrier. If more than 14 days have lapsed since the last time you verified coverage, repeat procedures.
- Identify the top payers and top procedures; determine if the services are payable and what diagnosis must be submitted. This is important, since the primary diagnosis determines medical necessity.
- When verifying coverage for network and non-network facilities, have the CPT, ICD-9 volume 3 code or DRG available to understand coverage and limits.
"In our center, because we are small, we are able to have one person handle every aspect of the billing, starting with pre-authorizations," says Ms. Orwig. "This helps us because we are able to see what is scheduled and with what insurance company so we can easily see what we will need to do ahead of time to receive reimbursement. I know what supplies we will and won't be reimbursed for and what kind of rules might be place on the service we are supplying. So if something unusual came up, it would be remembered, documented and then billed accordingly.
4 Fax claims to payers
Why? So that you have proof that the payer received the claim. Think of a fax as a receipt, time-stamped and everything. "We had a number of carriers telling us that they didn't have such-and-such claims on file," says Ms. Bowen. "We started faxing claims to them and keeping a report saying that the fax was successfully transmitted."
5 Collect co-pays on the day of surgery
You have one good chance to collect a co-pay: the day the patient shows up for surgery. Miss this opportunity, and chances are you'll be left chasing the co-pay and probably never catching up to it.
It's real simple, what you have to do: After verifying insurance benefits pre-operatively, your biller should call the patient, inform him of his co-pay and request that he bring the payment with him on the day of surgery. To make things more convenient, accept credit cards and debit cards.
"When you tell patients that you'd appreciate it if they brought the co-pay with them, most of them do so," says Mary E. Doutt, RN, the facility administrator at The Surgery Center at Cranberry in Cranberry Township, Pa. "The funny thing is, a lot of patients aren't even aware that they are responsible for a co-pay."
How much money could you be leaving on the table? Let's say you do 25 cases on a busy weekday and each patient is responsible for a $75 co-pay. Do the math: That's $1,875. "It is not just a few bucks that you're collecting. It's a good chunk," says Ms. Doutt.
"The upfront collections is something that we just started enforcing this past year," says Linda Wright, BBA, CPA, the chief financial officer at the Central Louisiana Ambulatory Surgical Center in Alexandria, La. "The patients complain about giving any money at that time. We find that if we don't make them pay up front, they won't pay at all in many cases. Still, we get complaints that they never had to give us money before."
6 Involve and incentivize staff
If Mr. Guetlein's facility maintains its aggressive goal of 32 or less days in A/R, he rewards them with paid time off. "They know they have to work hard at this and they do," he says. This normally equates to two full days off with pay per month for each employee in the office, not just the ones directly responsible for collections. Each employee earns, on average, $15 per hour. With four employees in the office, it comes to about $960 per month - not much, says Mr. Guetlein, when you consider all of the money spent chasing the revenue when it hits 60, 90 and 120 days plus on the aging reports.
"I leave it up to them to work out the logistics of the schedule so that there is no shortage of coverage in the office on any given day," says Mr. Guetlein. "By empowering them to schedule it how they want, it also gives them more ownership in their jobs and they continue to perform at high standards. They don't always meet the mark and when they don't I am cautious to react too fast as some circumstances are beyond their control."
7 Offer patient financing
Surgery centers have no business being in the banking business, say experts. "We try everything we can to avoid payment plans with patients," says Ms. Ziegler, one in a growing number of facilities that offers its patients the option of financing their deductibles, co-pays or the entire cost of surgeries with a healthcare credit company. "Let's say a patient has a $500 deductible and a 10 percent co-pay on a $2,000 surgery - $700 is a hardship for some," says Ms. Ziegler.
Ms. Ziegler uses one such company, called CareCredit, in business for 20 years, four years ago acquired by GE and today the country's largest patient financing company. Her facility gets paid in two business days and patients, 55 percent of whom CareCredit approves for credit, make arrangements with the healthcare credit company to repay an unsecured, revolving line of credit.
Physicians Surgical Center paid $395 to establish an account with CareCredit. Let's say a patient is approved for $1,000 in credit. You'd receive your money in two business days electronically. If the patient makes his payments to CareCredit in 90 days or less, it amounts to a no-interest loan. And as the patient pays it down, that money becomes available again.
"It's like a credit card, but dedicated for health care. It increases cash flow and eliminates the need for billing and hence accounts receivable," says Rob Morris, the vice president of marketing for CareCredit. "If you get a TV from Circuit City, you can get 12-month, interest-free financing. We offer the same thing, but strictly for health care."
CareCredit offers interest-free financing for up to 18 months. Two-, three-, four- and five-year terms are available to patients at 11.9 percent interest. Care Credit charges the facility 5 percent on a three-month plan, or $50 of $1,000.
Owing to their high self-pay and elective characteristics, ophthalmologists and cosmetic surgeons so far have been CareCredit's strongest customers, says Mr. Morris.
8 Sell your accounts receivable
Selling accounts receivable to access capital before payment is popular with many types of businesses, and it's gaining favor with healthcare providers. The practice, also called medical factoring or medical receivables funding, works like this: A funding company purchases your center's outstanding receivables, thereby assuming an ownership position in the receivables.
"So instead of waiting 30 to 60 days and beyond for payments on your A/R, you can receive up to 70 percent to 80 percent of your net collectible receivable in cash now," says Kent D. Harlan, CPA, the president of Ozarks Capital Funding in Springfield, Mo.
There is no monthly debt service because the funding is not a loan. Factoring fees can be much less than paying a billing company. The minimum monthly invoices is $25,000 and the maximum monthly invoices $100,000
9 Think like an insurer
Before she began billing at a surgery center, Ms. Rhodes sat on the other side of the table, working as a claims processor for a large insurer. It was there that she learned the key to getting paid for orthopedic implants: Submit your claims with all the information the insurance company could possibly require. Doing so removes any excuse the insurer might have to delay processing your claim. This means when you bill for supplies and hardware, include along with the diagnosis a detailed description of what implants and hardware you used.
For example, document for the claims adjuster how many screws you used in the case, the sizes of the screws and the types of screws. It's helpful to submit such cases as paper claims so you can more easily document this information. You can count on your claim getting denied if you don't give the insurer a detailed description of the implants you used. Even when you follow this advice, insurers will deny some of your implant claims. If your orthopedic implants are denied, refer to the Complete Global Service Data for Orthopaedic Surgery to see whether that implant can be carved out of the primary procedure. Always appeal denied claims. Insurers count on you not following up on denials. Be persistent. You won't always be paid at 100 percent, but chances are you'll be partially compensated if you're persistent, says Ms. Rhodes.
10 Divide and conquer
Set aside certain days to do certain billing tasks, says Lynne M. Adams, CMA, the business manager for Digestive Health Center of Indiana in Indiana, Pa. For example, Monday's are for charge posting, Tuesday's are for secondary insurances, Wednesday's are for denials, Thursday's are for back bills and patient bills, and Friday's are for check posting.
"We've found that if you do certain things certain days, it gets done quicker," says Ms. Adams. "Our claims are never just sitting out there in limbo. They're getting out quicker so we're getting responses out quicker.
Another tip: Assign each payer to a certain employee and have policies and procedures in place that require her to follow-up on all filed claims within 30 days of service and at regular intervals thereafter, says Ms, Wright, whose facility employs five people in the billing department.
"We're a big center," she says. "One person might do Blue Cross and Medicare. Another worker's comp and Medicaid. Another might do commercial. It easier to spot problems if you become expert in certain payers."
11 Outsource your coding and billing
Some outsourcing companies charge a percentage of gross collections. Serbin Surgery Center Billing, for example, keeps 4 percent to 5 percent of collections, depending on whether you're a multispecialty (higher) or a single-specialty center. Others charge a per-case fee. National Medical Billing Services, for example, charges Ms. Ziegler's center $12 per case it codes. Regardless of what the service costs, the rationale remains the same: professional, dedicated coders can speed and increase reimbursements. Why? Because it's all they do.
"People in your office cannot spend all of their quality time doing a job they're assigned, such as collections, because they have to answer the phone and back up scheduling and other things," says Judith L. English, the vice president of operations at SSCB. "When you outsource to a company that only does that, that's their whole job and they spend eight hours a day doing that."
12 Stay on top of clearinghouses
Make sure staff submitting electronic claims understand the clearinghouse's denial and reporting process so they can correct any problems upfront rather than waiting 14 days for denial, says Ms. Bentin. Scrubbing software identifies all kinds of problems and automatically tells you whether a claim has been accepted or rejected, she notes.
As you probably know, a clearinghouse will send you a report detailing what's been sent and what didn't go through. For example, a claim might have an invalid ID number, invalid place of service (physician office vs. surgical hospital), ICD-9-CM or invalid CPT. The key is to rework the claim then and there and resubmit it.
"Get hold of claims that are kicked back, review and resend," says Ms. Bentin.
13 Only contract with payers that pay promptly
This may be a bit of a hardline stance, but you certainly have the option to send patients with slow-paying coverage to another center, as some of our readers suggest. You can also choose to not contract with payers that aren't prompt payers.
Don't forget the blocking and tackling
So, there you have it, 13 tips you can apply to get paid faster. Before we go, here's another reminder on the importance of submitting clean claims.
"It takes such a blend of many talents to get your claims paid quickly," says Ms. Orwig. "Of course, it helps that you have the correct information upfront. I know it might seem like a trivial thing and everybody knows it, but it is one of the most important things you can do to receive timely payment."