PRESENTED BY MSG ONLINE WEBINARS COPY WRITE 2010© Medical Billing Continuing Education Course.

PRESENTED BY MSG ONLINE WEBINARS

COPY WRITE 2010©

Medical Billing Continuing Education Course

www.Onlinewebinars.info

Table Contents

Improving accounts receivable collections Current trends for accurate claims

submission.Claims follow up techniques Winning appeals How to evaluate you’re A/R The new regulations and provider

compensation for EHR .


Improving accounts receivable collections

A/R Collections starts at the front desk

1. Accurate collections of client information.2. Confirmation, is there another insurance, name

of insured? 3. Obtaining required signatures4. Up-dating client information 5. Collecting co-pays

Accurate claims submission can only happen when there is accurate data to submit.


Improving A/R Collection Ratios.•Step #1 Insurance Verification.

Current Trends

Verify patient’s plan benefits for services you plan to offer.

Verify the billing address.Estimate cost for services,

insurance payment and patient balance.

Document the information obtained and make it available to follow-up/collection staff.


Documentation

Patient Registration Form

Area to list more then 1 insurance.

Emergency contact information

Assignment of benefitsFinancial responsibilityRelease of medical

informationStatement of patient

confidentiality.


American collections association and the US Department of Commerce surveys have concluded A accounts receivable collections depreciation

Months Past Due1 MO. 3 MO. 4MO. 6MO. 12MO.

Amount Collected

100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

Losses

5%

26% 35%

70%

90%

Early A/R collections is a major key to limiting profit lost and increasing profit gain.

$1.00 .95 .74 .65 .30 .10


Verification of Benefits Sample

Doctor ordered a endoscopic procedure.Estimated cost $1400 (outpatient, in the office procedure).

Per insurance verification, patients benefits are as follows.With authorization from the insurance benefits are as follows.

Deductible: $250 (to-date -0- met). Then Insurance will pay $80% Patient 20% of allowed amount.

Procedure $1400 less deductible, which is patient’s responsibility. Total Billed Ins pymt Pt Bal$1400 less $250 ded = $1150 x 80% (estimated ins bnfts) $920 $480 (patient’s balance is $250 deductible + $230 (the 20% of 1150). Using the above estimate, the office staff can make payment arrangements with the patient before services are rendered.


A/R Collections Tips

Follow-up to insurance carriers on the status of a claim.

Respond to inquiries for information timely.

Complete request for authorization to treat, immediately!


Definition: Clean ClaimCMS 1500 for Professional Provider Claims

A accurately completed CMS-1500/ UB04 claim form submitted within the timely filing period, as required of the insurer.

Current trends for accurate claims submission


Improving A/R Collection Ratios.

Step #2 Accurate and timely claim submission.

Communicate claim timely filing limits with staff, per payers.

Bill electronically using a clearing house.

Review acknowledgement reports

Complete CMS 1500 per Medicare regulations

Follow-up submitted claims with-in 10-15 days.


Resources to Stay Up-to-Date• Insurance company provider manuals

• Seminars and continuing education

www.Onlinewebinars.info www.justcoding.com www.AHIMA.org www.AAPC.com

• Federal Register document Government published updates, revisions changes, and deletions in laws. November and December issues contain outpatient facility updates.

http://listserv.accessgpo.gov

• Reference Materialswww.PMIConline.comCPT, ICD, HCPCS

Guidelines.

http://www.onlinewebinars.info/

http://www.justcoding.com/

http://www.ahima.org/

http://www.aapc.com/

http://listserv.accessgpo.gov/

http://www.pmiconline.com/


Winning Appeals

Step One

Compare the EOB/RA with the insurance verification information.

Step Two Review the reason for denial or

short pay Step Three

Determine if an appeal is warranted.

Step FourCall insurance carrier for denial explanation. Or review denial on web site of carrier.

Step fiveAsk what is the best way to appeal.


Items neededA time periodTotal A/R (billed amount) for that time periodTotal payments collected for the same time period.Example:

Jan 1, 2008 – December 31, 2008Total Collected ÷ Total Billed = Collections Ratio226,000.00 421,322.00 54%

How to calculate the collections ratio of your practice.

How to Evaluate Your Facilities Accounts Receivable


E L E C T R O N I C M E D I C A L R E C O R DE L E C T R O N I C H E A LT H R E C O R D

Y O U M U S T S TA RT N O W. M A X I M U M I N C E N T I V E S ( I N C LU D I N G $ 3 , 0 0 0 B O N U S ) W I L L B E PA I D A S F O L L O W S :

$ 1 8 , 0 0 0 F O R T H E 1 S T Y E A R$ 1 2 , 0 0 0 F O R T H E 2 N D Y E A R$ 8 , 0 0 0 F O R T H E 3 R D Y E A R$ 4 , 0 0 0 F O R T H E 4 T H Y E A R$ 2 , 0 0 0 F O R T H E 5 T H Y E A R

Q UA L I F Y I N G U N D E R T H E M E D I C A I D P R OV I S I O NP R OV I D E R S Q UA L I F Y I N G U N D E R M E D I C A I D A R E E L I G I B L E F O R U P T O $ 6 3 , 7 5 0 OV E R S I X Y E A R S. Y O U R PAY M E N T I S C A L C U L AT E D A S

8 5 % O F T H E E H R C O S T ( U P T O $ 2 5 , 0 0 0 F O R T H E F I R S T Y E A R ) , A N D 8 5 % O F A N N UA L C O S T ( U P T O $ 1 0 , 0 0 0 ) OV E R T H E

F O L L O W I N G F I V E Y E A R S. T O Q UA L I F Y F O R T H E M E D I C A I D P R OV I S I O N, AT L E A S T 3 0 % O F Y O U R C A S E S M U S T B E

ATT R I B U TA B L E T O M E D I C A I D. F O R P E D I AT R I C I A N S, T H E M I N I M U M P E R C E N TA G E O F M E D I C A I D PAT I E N T S I S R E D U C E D T O

2 0 % . H O W E V E R , O F F I C E - B A S E D P E D I AT R I C I A N S A R E O N LY E L I G I B L E T O R E C E I V E U P T O T W O T H I R D S O F T H E M A X I M U M

PAY M E N T.

EMR/EHR are here to stay!


EHR Incentive Program


EHR Continued


To Qualify for the Incentives (Continued)

There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of 2011. Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%).

Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for

up to $44,000. The total amount that you receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to 2015. You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment


Summary of the EHR Incentive

How you can Qualify for your Incentive Payment:The stimulus package passed for the year 2009 pumps $19 billion into the medical industry to help implement technology that makes healthcare safer and more connected. Those who prove meaningful use of Electronic Health Records can receive an incentive reimbursement of up to $64,000 over six years. Hospitals can qualify for $2-8 million in funding. Remember, 70% of the incentive comes within the first two years. This means that in order to receive the maximum reimbursement, you must start early. It is believed that the definition of meaningful use will be very similar to the CCHIT certifications. For more information on CCHIT certifications, see cchit.org or click here.The definition of "meaningfull use" includes:Use EMR software at point of carePrescribe electronicallyChoose an EMR that ensures interoperability or data sharingUse an EMR capable of clinical reporting

http://www.cchit.org/


EHR Continued

2011 qualification criteria also includes: 90 day reporting period to prove meaningful use through required measures At least one clinical decision support rule relevant to a specialty or a high clinical priority Electronic claim submission to payors Electronically check insurance eligibility (when possible) Provide patients with timely electronic access to their health information; Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the

time of discharge; and Require the capability to exchange health information where possible in 2011, with participation in a national

health information exchange by 2015 *By 2013, it is also expected that criteria will extend to include the ability to provide patients with access to

their personal helath records populated in real time. Here's How it Works: There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but

not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of 2011. Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%).

Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for up to $44,000. The total amount that you

receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to 2015. You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment,


CONCLUSION/QUESTIONS


PRESENTED BY MSG ONLINE WEBINARS COPY WRITE 2010© Medical Billing Continuing Education Course.

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Transcript of PRESENTED BY MSG ONLINE WEBINARS COPY WRITE 2010© Medical Billing Continuing Education Course.