1. Verify insurance coverage before surgery. Staff should call up the insurer to verify coverage before surgery. “The extra work pays off each time coverage cannot be verified,” Mr. Brown says.
2. Ensure on-time patient collections. Contact patients 3-7 days before surgery to explain their financial responsibility but no earlier than that because they will forget about it. Accept as many forms of payment as possible and be able to offer a payment plan if needed. “Once patients receive the service, paying for it is no longer on the top of their mind,” Mr. Brown says. “Getting the money while they still need the service is key.”
3. File claims in a timely manner. “Claims should be out the door 48 hours after surgery,” Mr. Brown says. Allow 24 hours to complete dictation and 24 hours to code and submit the bill.
4. Follow up after submission. Review the progress of submissions daily with the claim processor. This can easily be done by visiting the processor’s website. “Finding out right after submission that the claim will be rejected because of a typo is better than finding out 30 days later when the payor rejects the claim,” Mr. Brown says.
5. Audit coding regularly. Hire an outside company to perform a comprehensive audit annually. The cost, in the neighborhood of $5,000, can easily be made up by finding just one or two cases that were coded wrong. “Finding a trend will pay for the audit many, many times over,” Mr. Brown says.
6. Look for the highest billable level. Sometimes lower-paying codes are accepted when a higher-paying code would be accepted as well. This is hard to know unless you review claims, because there won’t have a rejected claim to alert you.
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