Thanksgiving for Healthcare in the US

With just a short time away, Thanksgiving is surely in the front or your mind.  Maybe it’s that growing grocery list on your kitchen counter or a half-packed suitcase in the corner of the room.  Maybe it’s the paper plate affixed to your refrigerator with a child’s hand traced on it disguised as a Tom turkey.  If it’s the latter, I bet it came with a repeated rendition of the story of the first Thanksgiving.

As most of us may recall, the typical grade school story centers on the pilgrims, slightly out of place in the New World, until they received some assistance from their local Native Americans.  Together they celebrated and gave thanks for a bountiful harvest.

With winter approaching the importance of that harvest could not be overlooked.  Many early settlers met with an early demise I am sure for lack of food.  Another major cause of deaths in those early settlers was disease.  Medical care was certainly not advanced at the time, but I am sure most went without any at all.

I bring this up because many Americans take the access to healthcare for granted.  According to the United States Census Bureau, in 2009 there were 48.6 million people in the US (15.7% of the population) who were without health insurance.  Unfortunately lack of health insurance severely limits access to appropriate healthcare.  The provisions in the Affordable Care Act, many times referred to as “Obamacare”, are aimed at extending healthcare coverage to all Americans.

This is a truly a polarizing subject, but I do not write about it to be controversial.  Instead I would like to focus on this point.  We very commonly hear that “Healthcare is broken”.  We are confronted daily with all the ways the ACA is not working.  Frankly, if the pilgrims only thought about how tough they had it, they would have gotten back on those boats and sailed back to where they came from.

They expected hardships, mistakes and hard work.  They were breaking “new ground”, exploring a “new world” and isn’t that exactly what the ACA is all about.  It’s an attempt to move our healthcare system forward, see the obstacles faced by many people needing medical treatment and find solutions to those problems.

So I am simply suggesting, instead of concentrating on the negatives or imperfections of the ACA or the entire “broken” healthcare system as wholes, we should look at the good parts and be thankful.

1.       Minimum levels of covered services are now mandatory for all insurers in the individual market.  They must also offer preventive services with no cost sharing for the beneficiary. 

2.       Preventive screening coverage items have been added for Medicare beneficiaries and the prescription drug “donut hole” has been closed.

3.       Most insurers can no longer deny coverage for pre-existing conditions.  This is of course great news for patients with chronic illnesses like asthma or diabetes and those with a history of cancer.

4.       The age for dependent coverage has been raised to 26.

5.       Individual and small group plan insurers can no longer charge more for coverage based on sex.  Currently 92% of health plans charge more for a woman than a man for the same coverage.

6.       Plans offered by individual, small group and Marketplace insurers must cover maternity and newborn care as well as vision and dental for children.  If our children start off healthy, this provides a good foundation for a healthy adult.

7.       The limits insurers could place on lifetime benefits for essential health services have been eliminated.  More great news for anyone who suffers from a chronic illness.

8.       Wide varieties of individual coverage options via the Health Insurance Exchange (HIX) for those who are just above the income limit for government programs.

9.       Increased access for the underserved in our communities to appropriate government programs.  By having access to insurance, thus care for minor issues and preventive services, many more complicated illnesses and diseases can be avoided.  Reducing costs for treatment in the long run.

November is Lung Cancer Awareness Month

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A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice. 

Click here to download your free White Paper.

Ensure Success with Optimum Biller Efficiency

As a fitness enthusiast who runs, bikes and lifts weights, I recognize the importance of measurements like distance, speed, weight and repetitions.
Since my goals are typically just to keep in shape or finish a fun race here or there,  I track my “numbers” the old fashioned way, in a simple notebook which is sophisticated enough for me.

For the more serious, competitive type athlete, the market is full of technical gadgets  to track those details and the more intricate things like heart rate, cadence, elevation change, etc.

It boils down to one simple rule:  If you want to have a good performance, you need to do the hard work and the measurements can prove you’ve done the work.

This same rule applies to the financial performance of your medical practice.  For it to be successful the work has to be done, but how do you know the work has been done and done well?

 With Iridium Suite Practice Management Software you can utilize an extensive variety of biller efficiency reports to evaluate your medical billing staff and the quality of their work processes.

Below I have provided the highlights of a few of the useful reports that can be generated:

 Biller Time Worked - This section of reports offers the ability to measure these statistics:

Daily Log - a running journal of how much time each day is being spent by each biller actively using the system.

Biller Time and Biller AR Revenue Comparison -  indicates the number of hours each biller has worked with the total amount of revenue collected as a result of that work.

Cost per Service Line Over-Time -  provides data on how efficient the biller is in accruing revenue by looking at the AR over time. The cost per service line is evaluated by measuring the number (#) of hours it takes to close a service line.

   Life of a Service Line – This section of reports allows measurements of all aspects of the “life of the service line” from origination to being closed:

The average time to invoice and close the primary payer.

The average time to close the secondary and tertiary payers.

The average time to invoice and to close a patient service line.

The average time to close the service line as a whole.

 Stagnant Accounts Receivables- This section of reports allows you to identify open service lines that have not been touched in a specified number of days, like 30. (You should provide billing staff with the expectation that each open service line should be reviewed and follow up actions performed as necessary in the allotted time frame. If ARs are not attended to, this can result in issues for “untimely filing” denials.)

  Biller AR Work Speed & Average Time to Close ARs Template - This section of reports provides the average time it takes a biller to close an AR. This is computed by taking the sum of the total days taken to close all the ARs a biller has worked over the count of ARs

 Average Number of Invoices to Close AR Template – This section of reports counts the average number of invoices sent out per service line responsibility. (Excessive invoicing is not only a problem in itself, but can be seen as a side effect of other issues and should be examined closely.)

 Another piece of the puzzle in keeping your AR cycle short, is avoiding denials.  Follow this link to an informative article “Prevent These High Volume Claim Denials” or if pictures are more your style check out this infographic.

Whether you are running a race or running a medical practice, it is important to utilize measurements of the work performed and keep your eye on the prize!

Diabetes Awareness Month is Now

How to Differentiate Between Global, Professional, and Technical Charges

Medical practices are almost as diverse as people in regards to the arrangements and agreements that exist between physicians and facilities. These varied fiscal arrangements make it necessary for medical entities to have a complete understanding of the nuances of global, professional and technical charges.  This allows them to properly bill their charges based on the specific portion of service that the entity is providing to the patient.  Understanding the definition of the CPT-4 codes, and modifiers, allows billers to accurately code the appropriate charge codes and payment modifiers.

A challenge that is common in Radiation Oncology coding due to facility based practices, is selecting the correct modifiers that are required to distinguish between the global, professional, and technical components of services. The modifier codes that distinguish these services are ‘26’ for professional components, and ‘TC’ for technical components.

For a facility based provider that is not an employee of the hospital, the professional component of a charge covers the cost of the physician’s professional services only.  When billing for the physician’s time and expertise, a 26 modifier is added to global CPT codes.  (Professional only codes, like 77427 do not get billed with an appended 26 modifier.)

For example: Typical billing codes used when planning IMRT radiation therapy treatment for a patient are 77301, 77300, 77338.  The 26 modifier when added to these codes indicates to the insurance company that the claim is requesting payment for the physician’s services only and not the use of the facility, or other support staff’s services.

 In a hospital based radiation therapy center utilizing contract physicians, the technical component of a charge addresses the use of equipment, facilities, non-physician medical staff, supplies, etc. Technical charges do not include the physician's professional fees, but include the use of all other services associated with the visit. (Technical only, like 77418 do not get billed with an appended TC modifier.)

Using the example from above:  The treatment planning codes 77301, 77300, and 77338 will have appended to them the TC modifier.  This will indicate the charge is for the technical component only.  In this case the medical claim is seeking payment for the facility costs and the costs associated with all supplies and staff except for the physician.

When radiation therapy services are performed in a free standing center or a hospital owned facility with employed physicians, all charges will be submitted globally.  In other words, a biller will bill global charges when there is no division of the costs associated with a medical service because the service was provided by a single entity. The global charge includes both the professional services as well as all ancillary services (like use of equipment, facilities, non-physician medical staff, supplies, etc.) associated with a patient’s care.  (Global charges are never billed with a 26 or TC modifier.)
So far we have discussed two billing scenarios: outpatient hospital based contracted radiation oncologist and a facility employed radiation oncologist.  Often a radiation oncologist can provide his or her services in a combination of these two scenarios.  They may be part of a free-standing (global) radiation therapy center(s) and also have contracts to provide (professional only) services for hospital based departments.

 In this case, it is crucial that office staff pay very close attention when they assign modifiers based on the place of service and the “portion” of the services provided.  If a global charge is billed with the ‘26’ modifier, the provider will be reimbursed at a significantly lower rate.  (In radiation oncology billing, the technical reimbursement portion always greatly exceeds the professional.)  If a professional charge is billed without the ‘26’ modifier, the provider will be overpaid at the global rate and/or could cause great difficulty for the facility when they file for their reimbursement.  (Any billing that causes overpayments can be construed by the payer as fraud, so even a simple mistake like this can have significant financial or legal repercussions.)

 One way to avoid these types of errors and greatly simply the coding of these complex situations is to utilize advanced medical billing software such as Iridium Suite by Medical Business Systems.  Because of programmable “Facility Tracks”, the software is able to recognize when to add a modifier, and which modifier to add based on the facility where the service was rendered.

Creating a Good Medical Billing Environment

Just the other day a blog post landed in my inbox referencing suggestions for a ‘Good Road Trip’.  It made me think, everyone can relate to this.  Who hasn’t at one time or another experienced a road trip?

Maybe you were stuffed into the backseat of the family car with your less than agreeable siblings, cruising down the highway at the blistering speed of 55 MPH for what seemed like an eternity to get to that paradise of Disney World or some other wonderful childhood entertainment mecca.

You might have crammed yourself and half a dozen of your closest college buddies into that same old family car; driving “straight through” just to be able to bask in the sun and get sand in your toes, and everywhere else, for just a few springtime days.

So with those experiences in mind, here are the suggestions I found and they do make a lot of sense:

1. Make sure there’s enough room. Agree: this eliminates the “Stop touching me” argument!
2. Pick your playlist.Agree: music calms the savage beast and sing-alongs are great fun!
3. Pick a good restaurant.Agree: people get grumpy when hungry!
4. Download Voxer. Agree: modern day “CBs” if you have more than one car!
5. Enjoy not flying.  Agree: almost every state has good scenery, appreciate it!
6. Take a break.  Agree: get out, take a walk, get fresh air, it clears the mind!

As this is a “Biller’s Blog” it’s time for the tie in, right?  Well here it goes.  I would guarantee that every medical biller out there has at one time or another been stuck in the room the size of one of those supersized luxury SUVs with at least one, maybe two, or (gosh I hope not) three other people.  And you are not there for the few hours it takes to get to your awaiting Nirvana, it is for 8 whole (or maybe more) hours a day, 5 days a week.  YIKES!

Now that you see where I am going, let’s translate those suggestions into “How to Create a Good Medical Billing Environment.”

1. Make sure there’s enough room. I am so glad this was listed as #1 in the article, because this is first and foremost my most important point.  All the other tips can be made void and useless if this is not adhered to.

                 

I suffered for many years in a room about 10’ x 10’ and no, it was not a jail cell.  It was the hospital’s “generous” gift of space to the radiation oncologists I worked for to use as their billing office.  This windowless tomb contained: 3 workers, 3 desks, 3 computers,  3 printers, 3 telephones, 2 bookcases,1 fax machine, 1 credit card terminal,1 paper shredder, and if this was a Christmas carol, a partridge in a pear tree.  

Definitely close quarters.  We had to coordinate the use of printers, faxing, shredding and phone calls between each other and around clients who may come in to discuss a bill, etc. This was not the most efficient way to work and also presented a “too close for comfort” issue in regards to personal matters on more than one occasion.

In order for billing staff to have the ability to focus on the intricate details necessary to properly perform their job, adequate space is crucial.

2. Pick your playlist.  This one is so much a “common sense” item; some people need a little “background” music to work.  I get that. 

It’s okay if you want to spend your weekends with glow sticks at a rave, slam dancing in a mosh pit or even square dancing around the community center, but no one wants to listen to that stuff in the office.  I am not suggesting you listen to that coma inducing “elevator” music either, just keep it simple, middle of the road stuff.  And keep it quiet, you will need to be able to talk over it easily and hear others speaking to you as well. 

3. Pick a good restaurant.  My take on this item is: hungry people (and people without their coffee) are grumpy people and they have trouble focusing, except on how hungry they are (or how much they want a cup of coffee).

                                                                   

If you know that skipping breakfast makes you starving by 10AM, pack a snack.  If you have a hard time getting out of the building for lunch, then pack a sandwich.  If your co-worker is constantly hungry (and grumpy and not focused), pack her/him a snack. 

The moral of this story is feed your body, it feeds your brain and that’s how you do your best work.  Also, make sure your break room is stocked with coffee and supplies!

4. Download Voxer.  We are now talking about communication.  This is often touted as the key to a good romantic relationship.  This is also necessary for good work relationships. 

                                                                             

It is important to know what tasks each person is responsible for in the billing office and have policies in place for how they are coordinated among the staff.  If certain tasks “overlap”, workers should make sure that others know the status of that shared project.

No one has time to repeat the same work as someone else in the office.

You should also let other personnel like front office staff, nursing staff and the physicians know who the “go to” person is for a specific request.  For instance to ask the accounts receivables specialist to get an authorization for a patient is definitely not the most efficient way to get things done. 

5. Enjoy not flying.  Above I alluded to every state having something to see, well in an office, every person has value.

                                                                                 

Get to know the strengths (and weaknesses) of everyone in the office.  Utilize this knowledge to facilitate assigning specific responsibilities.    Diplomacy is not unique to the United Nations, in close quarters like an office, being aware of the personalities of the staff can prevent  a mild conflict from escalating into a Human Resources emergency.

6. Take a break.  Coffee breaks, lunch breaks and vacations, each serve the purpose of giving us time to recharge and rejuvenate. 

            

A lunchtime walk in the park, catching up on current events in the newspaper, and an out of town adventure, are all good ways to get a fresh mind and relaxed body. (I would not suggest the paper airplane, but some good hearted humor goes a long way in making everyone’s day brighter.)

Taking time to step away from the work produces more clear thinking, enthusiasm and productivity.  It also makes for a happier employee.

So if you can picture your situation to be like a road trip, and follow these suggestions you will have all the key elements to having a successful and harmonious medical billing office. 

                              

Its Time for Your EDI Checkup