If you are submitting your claims electronically, you need to have a system in place for keeping track of the batches you send. In our office, we send multiple batches of electronic claims every day, to multiple insurance carriers. But even if you are only sending one or two batches a day, it is important to track them.
Sometimes it is necessary to refer back to a batch. If there is a problem, or if the batch is rejected, you need to be able to identify exactly which batch it was. Usually your batch is assigned an interchange number, or batch number. Our software allows us to resend an entire batch with one command as long as we know the interchange number. This is a huge timesaver.
Also, if you are checking your electronic reports, you should be checking off the batches that are received ok and accepted. If you aren’t keeping track of your batches, that wouldn’t be possible to do. We find that occasional a batch just never gets acknowledged. It is sent without any problems, but no report ever gets received stating the batch was received and accepted. If we didn’t keep track of all the batches and mark them off as we receive notification of acceptance then we would never know it got dropped. Considering the number of batches we send, this ends up being a considerable amount of money.
If you batch your claims once a week, and a batch gets dropped inexplicably and you are unaware, it could mean a week without the regular Medicare or Blue Cross check coming in. Unless you are doing regular follow-up, the missing batch may never be caught. That’s a lot to lose. If you are batching your claims daily it may not be such a problem, but it is still money that is lost in the system.
In our office we have a notebook, the electronic log book, which we record all electronic batches in. Whenever someone batches claims, they write down the date, Provider (since we bill multiple), interchange number, and the carrier it is going to (i.e. MCR for Medicare, BC for blue cross, etc). It sounds complicated but it only takes seconds, and it is usually done while the person is waiting for the dial up or batching process so they are idle anyway. Then when we check the electronic reports and we receive notification that a batch was received we highlight it in the electronic log book to indicate it was received. Then when you look at the electronic log book it is easy to pick out when a batch has not been received and you can act on it right away!
Of course in order for this process to work you must be downloading and reading your electronic reports, but that’s a whole different article!
Subscribe to:
Post Comments (Atom)
2 comments:
Thanks for the great site! I am a newly graduated cardiologist and have just begun how important the biller's job is. I'd like to ask what your advice is in getting going. I joined a solo cardiologist who uses and outside billing service. How do I know she is doing the best job and what info do ask for?
Also, when I compile inpatient consults, what's the best way to maximize my reimbursement? I know there are many details, but I'd benefit a ton if I just learned to avoid the most common mistakes. Thanks for the site and your attention.
Congratulations! It must feel good to finish such a great accomplishment. If you are joining with the solo cardiologist as a part of his/her practice and you will be using the same biller, then I would recommend asking her what reports she will be giving you on a regular basis. If she doesn't give reports regularly, or if she finds your request odd, I would be careful. It is not uncommon for a provider to want reports to monitor how they are doing. Anyway, by requesting them you will be letting her know that you are going to be paying attention. Also, ask you 'partner' what they do to keep track of how the biller is doing. They may already have a system for monitoring her. I would look for the amount being billed out, the amount being collected from insurance, and the amount being collected from patients. Also, you will want to watch the percentage of outstanding over 30 days. There should be less than 15% of $$ out over 30 days (10% is even more desirable).
As for the inpatient consults, make sure you bill the level that fits your visit. You don't want to just bill the same level all the time. Medicare and other insurance companies monitor the codes that you bill and it is a flag if you use the same level over and over. Also, your notes must reflect the level. Don't forget to indicate the dr who requested the consult, as it is required by most insurance carriers. I pulled the following rule from another site that might be helpful.
Consultation Versus Visit–Pay for a consultation when all of the criteria for the use of a consultation code are met:
(1) Specifically, a consultation is distinguished from a visit because it is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source (unless it is a patient-generated confirmatory consultation).
(2) A request for a consultation from an appropriate source and the need for consultation must be documented in the patient’s medical record.
(3) After the consultation is provided, the consultant prepares a written report of his/her findings which is provided to the referring physician.
Best of Luck
Michele
Post a Comment