Whether you run a single-physician practice, a group practice, or a larger surgical center where a mix of basic and complex procedures are routinely performed, it’s safe to assume you have regular billing and medical reimbursement tasks that need to be completed in a timely and efficient manner. Because there are so many factors that can affect your ability to generate sufficient revenue to maintain your practice, it can be helpful to have the right kind of assistance. Fortunately, we’re prepared to help you with all of your medical reimbursement needs at Advanced Reimbursement Solutions.
Avoiding Medical Coding Errors
Based on current American Medical Association terminology, the Healthcare Common Procedure Coding (HCPC) System is one example of the type of coding knowledge that’s important to have when making patient data entries. Even if oversights with coding are innocent mistakes, errors discovered later can raise red flags and be considered forms of fraud and abuse.
“Fraud” is an intentional coding discrepancy. However, the AMA considers “abuse” as the type of coding errors that may be honest mistakes. For example, a misunderstanding of the coding system may result in a coding error related to a more complex procedure or service that was provided. By letting our medical reimbursement specialists review your codes, you could avoid one or more of the following common coding mistakes:
• Unbundling: Using multiple codes when a single code is available that covers the various components of a procedure.
• Upcoding: Billing for excessive services or patient time – e.g., a patient asks a question that takes about 10 minutes to answer and their insurance provider is billed for a standard 30-minute visit.
• Incorrectly using injection codes: If a patient has multiple injections done during a single session, only one injection code needs to be used.
• Not documenting unlisted codes: It’s perfectly fine to use an unlisted code to bill for certain services that do not have an appropriate code. However, these codes need to be documented.
Addressing Contract and Billing Rate Issues
The purpose of a medical contract is to establish specific terms for medical reimbursement procedures. A well-drafted contract defines the roles and responsibilities of all involved parties with regards to details such as pricing, terms of the arrangement, clarification of what constitutes a violation of the contract terms, and how the reimbursement process with be handled.
Our medical reimbursement staff can review your medical contracts to determine if responsibilities are clearly defined. Furthermore, we can look for any billing rate issues that may need to be addressed sooner rather than later.
A State-of-the-Art Billing System
One of the things HIPAA (Health Insurance Portability and Accountability Act) does is establish and manage electronic medical transactions. Medical providers are also required to keep patient records in electronic form. However, it’s not always easy to stay current with the software and related technology that’s needed to accurately and efficiently record and maintain updated patient billing information.
In order for the medical reimbursement process to be effective and beneficial for your practice, you need to have updated records. If obtaining the technology required to do this isn’t in your budget right now, we can lend a hand. We have a state-of-the-art billing system you will have access to once you become a client.
Having your patient billing data safely and conveniently housed in a state-of-the-art system also allows our staff to request redeterminations, when appropriate, if you are not satisfied with the initial decision involving a submitted and filed claim.
Additionally, our state-of-the-art system can be used to spot instances of an account that was overpaid. If we find that an overpayment was made, we’ll quickly initiate the recoupment process to secure the appropriate medical reimbursement. Over-payment sometimes occurs for the following reasons:
• A lack of awareness of other health insurance coverage a patient has
• Payment was made for the same charge more than once
• A claim was paid for an ineligible beneficiary
• Payment was made to the wrong health care provider or individual
Also, since our system is Web-based, our services are accessible to any health care facility or medical provider in the United States. Additionally, the use of updated technology on our part means the errors discussed above may be avoided in the first place, which could contribute to fewer instances of recoupment.
Tracking Your Initial Billing Efforts
One of the challenges with medical reimbursement is keeping track of the initial billing process. Because an important goal we have is to increase the profitability of our medical clients, one of the steps we often take is to track the response to initial billing efforts. If we spot instances of late, delayed, or incomplete reimbursements, we can take the necessary steps to attempt to remedy the situation as quickly as possible.
Minimizing Commercial Health Insurance Claim Headaches
Most medical practices deal with a combination of medical reimbursement processes. Some claims are handled through Medicare or Medicaid. Other claims are handled through commercial health insurance companies. Normally, any type of claim is submitted and reviewed and a decision is made.
While Medicare and Medicaid often have very specific and uniform reimbursement guidelines, this isn’t always the case with commercial health insurance. One of the most common and costly headaches for a medical practice is to have a commercial health insurance claim unexpectedly denied.
Because of our knowledge of various appeals processes, our medical reimbursement staff can quickly find out why a claim was denied. Common reasons for denial that we may be able to resolve or respond to include:
• Inaccurate or incomplete patient insurance information
• Lack of prior authorization for the service(s) provided
• Insufficient information about the reasons for tests or procedures
• Failure to file a claim in a timely manner
• Deeming a procedure medically unnecessary based on the information provided
With denials of this nature, we can find the reason for the denial and determine if there is a way to resolve the issue. If this isn’t possible, then steps can be taken to file an appeal. In some instances, a denial is overturned once the necessary information is provided. While we can’t predict what the outcome of an appeal will be, we can tell you that we’ll ensure a proper appeal is filed in a timely manner.
Medical reimbursement steps can also be taken if claims are underpaid or unfairly delayed. Because we deal with commercial insurance providers throughout the United States, we maintain knowledge of various state laws. This knowledge allows us to spot possible violations of state insurance regulations pertaining to claims that may apply to your situation.
Avoiding Patient-Provider Conflicts
If your practice isn’t receiving medical reimbursement payments on a regular basis, you may have instances where you’ll need to bill the patient directly. While it’s understandable to take this step in an attempt to receive payment for services, doing so may create unintended conflicts between billed patients and their health insurance providers.
By setting up a reimbursement process that works best for your practice, we may be able to minimize the need to revert to direct patient billing. One way we do this is by tracking the status of your claims. Being diligent about reimbursement can also make things easier for your patients since they won’t have lingering concerns about whether or not their medical expenses have been sufficiently covered.
Providing an Added Incentive for Patients
Turning to ARS for your medical reimbursement needs can have some unexpected perks. One of these is your ability to retain existing patients and attract new ones. You are also welcome to emphasize the fact that you are working with a top-notch medical reimbursement company in your marketing materials. Both existing and potential patients may find this detail appealing for a number of reasons.
Handling Complex Claims
Not all medical reimbursements involve simple office visits or procedures. If you are running a surgical center, for example, you may routinely perform complex procedures that involve many different steps and services. From the initial diagnostic testing to the administering of the anesthetic and the performing of the actual procedure and the various processes involved with it, every billable step involved with complex surgeries needs to be properly accounted for so requests for reimbursement can be submitted as per insurance guidelines. A more efficient reimbursement of complex claims may contribute to benefits that include:
• Increased reimbursement
• A boost in total revenue
• Reduced stress about having to attract new patients primarily to offset an uneven flow of revenue from reimbursement issues or delays
Improving Initial Reimbursements
Of course, every situation is different, but when medical reimbursements are handled diligently and meticulously, you may notice a spike in initial reimbursements. An increase in initial reimbursements could ultimately contribute to a pure profit boost. Part of the reason for this is because of a reduced need to directly bill patients and deal with payment collection delays.
Streamlining Reimbursement for Nursing/Physician Assistant Services
We also submit initial claims and redeterminations for services provided by physicians’ assistants. We can take care of the same processes for medical facilities that provide certain nursing services that are normally covered by a patient’s insurance. Similar steps can be taken with services provided at physical therapy or rehab centers.
Talk to the Experts to Learn More Information
Spend more time on patient care and less time dealing with medical reimbursement and the related steps involved with this process by taking advantage of the resources and services available from Advanced Reimbursement Solutions. We have offices in Wilmington and Phoenix. Contact us today to learn more about our services and how they can help you and your medical practice. We look forward to hearing from you!