Home Forums Discussions General Discussion Starting to do our own billing

From the posts I've read this past year or so, we are going to use Office Ally. Any words of wisdom for us jumping into our own billing? We have been reviewing RAs and EOBs for the past year. We've gone to some workshops and we really need that extra money. Words of wisdom would be appreciated. Thanks in advance

What is the most important thing we should know about submitting our own billing?

What are commonly made mistakes by new submitters?


*****Thanks in advance if you have answers to either of these questions****

I think that you have to watch the biller so that they don't get behind. You only have 60 to 90 days to submit the bill to insurance company so that all your hard work may be for nothing if billing isn't on the ball.

We use office ally and you plug in the numbers and codes. If it is done right then you get your money. If not then delays can be bad for business.

Thank you so much.
We will be starting about Jan 1.
We are trying to learn as much as we can now.

Will keep an eye on my biller to be-husband.

I just started doing this with my office manager/wife for the past 3 months. It is really A LOT easier than we initially thought it would be. Sure, it can be a pain sometimes but not overwhelming. The most frustrating thing is not putting it into the PM system, or even having it scrubbed to assure it can be sent to the clearinghouse...the most frustrating thing is denials for little stupid things like forgetting to dot an "i" or cross a "t". Then we'll resubmit it with the correction and it happens again. The part that is terrible is being on the phone with an insurance company for 30minutes and still not sure if what they tell you will work.

All that being said, my wife says she thinks she spends a total of 10 hours a week doing our billing and she really does a good job.

1) Don't let any denial go forgotten 2) Check your clearinghouse reports every single day 3) Code correctly 4)Review your EOBs closely 5) If in doubt, bug the crap out of the insurance.

Unfortunately I know someone who works at Blue Cross. He told me that they are pushed to look for a reason to deny a claim (especially the big ones). He says they like the percentage to be close to 15% denial on the first pass through. I don't know how true that is but it makes sense.

I am sure the insurance companies are pushed to find reasons for denials. Not so much now days but several years ago one could almost sense that HCFA's received on Fridays got tossed in the garbage cans. We made it a policy (before filing electronically) to mail out our claims in a manner that they would not arrive on Fridays. In addition, it was common place for us to mail several HCFA's in the same envelope when they went to the same address. Inevitably we would note that we received payment on all but one. A call to the insurance company would produce the response "We never received that claim". Our response would be "How in the Hell could you have not received that claim when you have already paid on the 4 others that were in the same envelope!!" Of course they had no reply other than, "I will check into that".
My addition to the excellent advice that Travis gave is to also run "Unpaid Claims" reports at least monthly and then nag the insurance companies until they are tired of hearing from you and they pay. In-house billing for me is a must. My collection rate is around 90% because I have hyenas for billing clerks...they will seek out and scavenge for every last penny I am owed.

Leslie

" have hyenas for billing clerks "
Love it!

Thank you all so much!
We are very small office and my staff takes a lot of personal responsibility for the practice and the patients. They are hyenas in training!! Actually, they have all gotten better/more comfortable at requesting payment as we go along because they see the connection between that and their paychecks.

Great advice.
My husband has been reviewing the eobs and ras for denials and getting the billing company to resubmit. He was worried that it might take a lot more time actually doing the billing, but maybe it won't after the learning curve. We have just signed up with Office Ally so we don't even know how to enter or scrub, but all in good time. We haven't been contacting the insurance companies. The service has been very nice, but doubt they spend the time pushing things through.

We attended a billing workshop with a woman who had been an Anthem (Blue Cross) employee who quit and went to work for one of the local hospitals because she said she couldn't live with herself with what they were asking her today.

Thanks again for taking the time and sharing your experience.

Wow, we have never even seen a report called "Unpaid claims". We were so caught up in just getting started that we just had this company do the billing after we coded it. Sounds like we have needed to do this for a long time. I like the idea of knowing what is going on with the business.
I am so proud of the folks I work with because they do take that responsibility for getting the copays and asking for payment. I love where I practice, but wish there was enough affluence to have a cash only practice.

Thanks again for taking the time and sharing your thoughts and experiences.

When posting your primaries, double-check to see if the patient has a secondary policy and be sure send that off for payment. Medicare usually, but not always, does this automatically. You can pile up a lot of uncollected secondary insurance payments and lose that income if it's not caught in time. Most secondaries won't pay after one year.

Great heads up. Thanks so much Dave

Ditto, Dave. It took me a while to realize that either Medicare was not always crossing over or the secondaries claimed they did not get it. When I run my "Unpaid Claims" reports I can specify secondaries only and then if something is older than 45 days after Medicare payment was received my biller is on it like a maggot on roadkill (sorry, I just can't help the analogies ). We then send those unpaid secondaries the Medicare EOB and the issue is resolved quickly.

Is there really an "unpaid claims report" in Ac or are we just talking about the financial report option?

Frank,

I do not use AC for my billing. I have a totally different PM program from which I can get an "Unpaid Claims" report. Sorry for any confusion.

Leslie