Good afternoon everyone, and welcome to today's webinar hosted by Patagonia Health. Today's webinar topic is billing best practices. My name is Denton and I will be your moderator for today.
Our presenter today is Debbie McNeil. She is the Senior Implementation and Training Consultant at Patagonia Health. Debbie has over 26 years of experience in medical administration, coding, and billing. She is certified in medical assisting, coding, and administration. Debbie provides training to medical staff and providers on the most effective billing practices that can help maximize reimbursement for their clinics.
She has also worked as a billing and coding consultant for public health departments, making her a valuable asset to any medical practice seeking to streamline administrative workflows and achieve their financial goals. We are happy to have her join us and share her expert knowledge on billing best practices in EHRs.
And without further ado, if you would like to take it away.
Thank you, Denton. Welcome everyone to this Happy Thursday. I hope your day is going well. Nothing like a good billing webinar, right? Hopefully you did not have a heavy lunch and we can learn a lot and glean information about best practices for billing in a medical office facility.
There are certain rules you want to follow as a biller, a checkout person, or anyone in your accounts receivable department. That includes your registration staff, because they are the first people your patient sees. Eligibility should be done at every visit.
What is important to the insurance company? We are talking money. There is reporting you need in your facility and a lot of information you gather from patients for reporting or clinical data. Today we are talking about what you need in order to get paid.
Real-time eligibility verification is very important to any software or medical facility, and it should be done at every visit. If we gathered all the denials across the nation, the main reason you would receive a denial would be because of eligibility errors. The patient may not have been eligible for that insurance on that day, or the information you gathered was incorrect.
There is human error in everything, so the subscriber ID, the patient's date of birth, and the patient’s gender are all important to a claim you file. Any one of those items could cause a denial. Without the correct follow-up, you can lose payment that could have been easily fixed by verifying eligibility and confirming accurate information.
The next important piece is claim status updates. Where is your claim? Did you send it? Is it at the clearinghouse? If you use one, is it at the payer? Did the payer reject it? Did they accept it? Should you be receiving an EOB or a paper payment?
You must also file your claims timely. Timely filing windows are getting shorter, not longer. Years ago, most payers allowed 365 days plus an additional 18 months. That is no longer true. Many MCOs, PHPs, and commercial payers now limit timely filing to 60 days from the original claim submission, and sometimes only 90 days to resubmit after denial.
Know your payers and know when timely filing limits are approaching. Submit the original claim quickly so you have time to work denials. A timely filing denial is very unlikely to be overturned.
Once your claims have gone out and postings have happened, you must work your aged accounts receivable report regularly. Capture anything that was not paid. Ask yourself:
Do not let claims fall into a black hole where you assume they will get paid. An aged A/R report should be sorted by the last date the claim was submitted so you know exactly how old it is.
You should have separate collection processes for:
Both must be monitored. Patient collection processes depend on your facility’s policies, such as sliding fees, indigency verification, or good faith collection efforts. All of these contribute to a healthy accounts receivable department.
Incorrect patient information is the number one cause of lost revenue. Not checking eligibility or submitting an unclean claim are also major issues.
An unclean claim can be compared to arriving at your mother’s house with dirty shoes. She will not let you in until you clean them. Clearinghouses and payers do the same: if required fields are missing or incorrect, the claim will not be allowed in. You must clean it and resubmit it.
Coding is another major issue. Medical facilities are paid fee-for-service, which means they are reimbursed based on CPT, HCPCS, and ICD-10 coding. You are only as good as your tools, so coding books or online resources are essential.
Local coverage determinations and provider manuals outline what payers consider medically necessary. If you keep receiving denials, review these manuals. For example, pregnancy tests must be medically necessary. A diagnosis of foot pain will not justify a pregnancy test.
Another major cause of lost revenue is simply not resubmitting claims. Submitting once and never following up results in lost money.
Debbie demonstrates navigating the demo environment, checking demographics, verifying patient information, and using real-time eligibility. She explains:
She then explains the household tab and how indigency is determined:
She then walks through the Electronic Super Bill (ESB):
In the billing module, she reviews:
She emphasizes that you must know where claims are at all times.
Debbie demonstrates:
She explains that without this process, payments disappear into a “black hole.”
Key principles:
She demonstrates closing claims that will never be paid (bundled services).
She explains:
Debbie:
We are at the three o’clock hour. I know I talked the whole time. I will leave it to Denton to decide whether we have time for Q&A.
Denton:
Thank you so much, Debbie. We are running low on time, but I want to ask a couple questions.
Question: When working on secondary claims from the primary remittance, but the secondary is entered after the claim is submitted, will it still appear under the secondary?
Debbie:
The primary must post for you to have the coordination of benefits to attach to the secondary claim. You cannot submit a secondary claim without knowing the patient responsibility or the secondary’s responsibility.
Question: On the household tab, do you have to have physical proof of income?
Debbie:
No. It depends on your facility’s policy. You must apply the same rule to all patients consistently. You cannot require paperwork from some and verbal income from others.
Question: Is the household tab where you check which services are covered?
Debbie:
Eligibility responses may show covered services, but the provider manual is the best source. Some payers send back details such as preventive coverage, deductibles, and amounts met.
Question: Is the household tab required for sliding fee scale?
Debbie:
Yes, if you offer discounts without proving indigency or good faith collection efforts. Otherwise, it violates anti-kickback statutes. Exceptions include rural health clinics and FQHCs.
Denton:
Thank you so much, Debbie, for sharing your knowledge. A video recording of this webinar will be sent out next week. To learn more about Patagonia Health and our integrated EHR, practice management, and billing solution, visit patagoniahealth.com.
Thank you everyone for joining us today. Have a great rest of your week. Take care.