1. Always indicate on claim form that documentation has been enclosed. One of the most effective steps that Ms. Kohlbeck takes in her billing process is to stamp each claim form with a notice that reads “Documentation Included.” Including documentation, such as a detailed operative note and implant invoices when billing invoices separately, with each claim form is a common billing best practice. However, claim forms and documentation are often separated and payors can lose track of supporting documents. Stamping each document lets payors know that documentation was included so that if it is separated for a claim, the employee processing the claim will be prompted to search document scans for the additional documents rather than assuming none were submitted and denying the claim.
Ms. Kohlbeck estimates that since stamping each claim form she has seen an 85 percent improvement in the length of time it takes for payors to process such claims.
2. Record any action you take or interaction you have regarding a claim. Ms. Kohlbeck says the most important step any biller can take to improving their billing success is to “document, document, document.” She recommends that billers include a note in the computer system for each action they take. For example, billers should enter a note indicated when claims were sent and list all supporting documentation. Anytime a patient calls to ask about a bill, that should also be recorded, in detail, in the system.
“When a payor calls asking for an invoice or operative note, you can look at your notes and let them know that you’ve already sent it and exactly when you sent it,” says Ms. Kohlbeck. “If a patient calls a physician’s office about a bill, you can provide the office with information about whether or not they called you and what information you gave them. It only takes a few seconds and it can save you a lot of hassle.”
3. Confirm all patient demographic information on day of surgery. ASCs should use the patient’s presence at the ASC as an opportunity to confirm all patient information necessary for billing. Demographic errors in claims, such as a misspelled name or incorrect member ID number, is one of the most common reason claims are denied. At Manitowoc Surgery Center, the registration and reception staff confirms all information.
“You really need to have high continuity and communication between your billing staff and registration and reception staff,” says Ms. Willhite. “Our registration staff collects this data when an appointment is made, verifies insurance and then confirms all information at registration. The billing process is 100 percent subject to the information entered at the time of registration, so it’s very important to have coordination between your billing and registration teams.”
The registration team should confirm several important pieces of information, such as spelling of the patient’s name, place of employment, insurer, ID numbers and whether or not the patient’s insurer or workers comp is being billed, says Ms. Kohlbeck. “Make sure everything is correct, including your modifiers, the -SG for the surgery center and all other modifiers, because errors could hold up a claim for months,” she says.
Learn more about Manitowoc Surgery Center.
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