Home Forums Discussions General Discussion Need pointers in doing my own billing

I think Drs doing there own billing is a cool concept. I admit during my 16yrs of practice, I have been totally ignorant about the coding & posting charges.

I recently found out, our biller/office manager (who I thought was very thorough & meticulous) has been putting in wrong codes for the Echos done at the office. The claims are being rejected for months, she did not do anything to find out & nobody knows what is going on till I found out by accident.

I need help in finding how to go about learning the billing, how do I skin this cat, so to speak. My earnings depend on putting the right codes in, & it scares the daylight out of me that the biller does not care. I do not know what else has been or is being posted incorrectly & I do not know how to check.

Any comments are appreciated, warm regards

Raj,

I am very involved in my billing operations. I do have a full-time biller and a dedicated PM program. Here are a few things I do to keep a check on things. I learned these by years of trial and error.
First of all, I personally run an "Unpaid Insurance" report the first of every month. I take it home with me and, using Logmein, spend an evening or two reviewing claims that have not been paid. Many times I will see that a code was entered incorrectly (for instance a "period" was inadvertantly placed after a code) or a modifier was used when it should not have been or vice versa. Also, I may see that the wrong diagnosis code was used for the CPT code. I use a paper superbill which I complete on each patient at the end of every visit and I circle the CPT codes and write in the diagnosis codes. Sometimes however, when the info is entered, it gets mismatched. I will highlight these errors and bring them to the attention of my biller. Also, I find claims that for reasons that are still unknown to me, never seem to have even been sent. Sometimes I think the PM program just misses them. Anyway, all claims over 30 days which are unpaid are then highlighted and the biller is instructed to call on these to get them paid or get them corrected. More times than can be explained, when she calls she will hear "We never got that one". (Which is funny because we still do a lot of paper claims and put several in the same envelope. They somehow got the other claims that were mailed together). If claims show up on the report the next month, she had better have a good explanation for me (many times it requires changing an encounter CPT to/from preventive care to problem-oriented care depending on one's insurance).
Another bugaboo are the so-called "cross-over" seconday claims. For many secondary insurances, Medicare is supposed to send the claim on to them automatically. In my experience, this does not always happen. This report will allow me to uncover these secondaries which have gone unpaid. We then file them ourselves. This has helped tremendously. I can also track how many times we have filed a claim. If a seconday has been filed twice and goes unpaid, the balance is then put to the patient. Let them dicker with their secondaries. This also has been very helpful.

Billing things like ECHOs unfortunately now involves using one code for Medicare and several others for commercials. If you are "leasing" these services, be sure to check with your vendors regularly. They should know of any coding changes.

I also run an "Accounts Receivable" report monthly for the patients with an aging over 30 days. I then check each one individually and most of the time add a late fee charge. After going over this report I then personally run the statements and look at every one. This gives me a very good idea of who owes what. I have made up some stickers with different messages on them such as "Important: Your Account is now Past Due" or "Final Notice. The balance shown must be paid within 10 days to avoid collections proceedings" or "Please call the office if you need assistance setting up a payment plan" or "Your insurance company has failed to pay your claim. The balance shown is now your responsibility". I put the appropriate sticker on statements, the biller stuffes and mails.
I know this sounds like a lot of work and intervention on my part and definitely I would prefer not to have to do it. But, in 21 years of practice and numerous "billers", I have come to learn that no one cares more about the bottom line than do I. And no one is more motivated to have it done right than am I. So, I do it myself and, really, it does not take all that long. More importantly, it keeps me in the loop and in the know. And, my biller knows she is being monitored. We all make mistakes. My staff catches things for me all the time. My biller needs someone to help her catch things also. And, if my biller were to suddenly walk out, I would not be in crisis. I can do it myself or at least know enough to train new people.
I also like knowing who owes me money. We physicians somehow have this notion we should not be involved in the financial side of medicine. I disagree. If I have just run statements and see that so and so who has a large balance is coming in today I will discuss this with them at their visit. I will send them to talk to the biller to set up a payment plan. Or, I will ask them if I can help them by changing their medicines or giving them samples or whatever. And, more times than not, I will "adjust" the charge for that visit.
And, lastly, seeing row after row of unpaid claims from a particular insurance company is so much more impressive to me than reading a summarized report. I then can make better judgements about which insurances to take and which to tell GTH.

I defintely favor in house billing.

Loquacious Leslie

Dear Loquacious Leslie,

If you don't mind sharing, which PM software package do you use?

VisonaryMed. Visonarymed.com. Many good things and plenty of bad things about it but I have been using it for about 11 years now and hate to change until Jon has something to look at.

Leslie

Thanks Leslie,