Friday, April 30, 2010

A Word on Medical Billing

I'm home sick from work today - crappy. Whatever has been going around my group of friends has finally caught up to me at the worst possible time, what with work being severely short handed and incredibly backlogged.

Instead of sitting at home being pathetic and sleeping all day I've been doing a lot of industry research (medical billing) - while being sort of pathetic and laying on my couch watching tv. What I'm finding isn't surprising. Everyone blaming the insurance companies (IC's) for not wanting to pay claims, not wanting to pay claims on time, etc etc and trying to find "streamlined" ways to bill so the IC's have to pay their claims. Take for example Bonnie Blanchfield of Massachusetts General Hospital who has developed a prototype for a streamlined medical billing system by using a single set of payment rules for multiple payers, a single claim form and standard rules of submission. I, personally, can't help but wonder how much time Ms. Blanchfield spent on this prototype and whether or not she's used it yet or if it's just a grand idea she has. I would like to see whether or not she can get all of her payors to agree to single contract.

I have a much simpler solution. A few solutions, really. Start with your staff - here's a list of questions:

1- Who are they? Is it your neighbors 16 year old daughter, or a billing professional with at least 2 years of experience?

2 - What is their background? Again - is s/he a high school student? Or has s/he worked in a medical office before? Does s/he have experience with insurance billing and IC's?

3 - What are their job responsibilities going to be? Answering phones, checking in patients, and taking payments are all jobs for anyone in your office. But when it comes to your billing the person who handles it should be knowledgeable and experienced. Starting there if you only use people who know what they're doing you should see a reduction in your errors.

Secondly - are you a participating provider, or par or are you non par? Par providers normally have a contract or some sort of guideline that the IC's must pay you by. Also insurance verification on your patients is of the utmost importance. You need to see what your patients contract says and whether or not the services you are about to perform are even covered. While it may seem advantageous to you to perform a non-covered service (and blame the insurance company for non payment) in the long run it causes you nothing but grief and many many hours sitting on the phone with the IC's and in some cases the patients themselves trying to collect your payment.

Lastly - look at your errors. What kinds of errors are you regularly getting? No authorization, invalid code, incorrect modifier? Find out how to fix it and train your staff (and yourself!) to do so. This is probably THE simplest thing you can do to get your claims through the computer system the first time before it hits the queue and goes to the examiners.

With a little bit of self examination you can reduce your billing time and increase your first time resolution on your claims.

Monday, April 12, 2010

Staying Focused When You Really Don't Want To

Let's face it . . . no matter how much you love your job there are going to be times when you just can't seem to keep your attention on your computer screen. We all know that along with the obvious drop in productivity there are several other not-so-great things that can come of being distracted, especially when you work in a quiet production environment like I do. If I'm speaking to a friend my managers can hear my voice, if they walk by my desk and I'm checking my facebook or twitter accounts on my Blackberry it can look like I'm completely glib about my job. But what can you do about it? Most of the time drifting is a completely subconscious activity - we don't even realize we're doing it until we look up and that same claim has been on the screen for 20 minutes.

The first thing you need to do is make sure you're taking care of yourself. Are you getting a reasonable amount of sleep? Are you eating a healthy breakfast (that does NOT include a $1 sausage biscuit from a drive-thru)? Are you drinking plenty of water during the day and getting at least 30 minutes of exercise? I realize that these factors are harped upon constantly from magazines and television shows but there's a reason for that! Consider yourself a machine - a production machine. That machine is going to need to be kept in order. Regular maintenance will need to be done, gears oiled, computers calibrated, etc, etc. If you don't take care of your production machine, it will run slower and break down more frequently.

When I'm having a day when I really don't want to be at my desk, like when it's a beautiful spring day outside or I'm tired, I personally make myself continuously click - for the type of work that I do it's actually a fairly easy way to stay moving. This may not work for everyone, but usually as long as your fingers are moving you're focused on what they're doing. There are, of course, days when that method simply will not work. If that's the case the next best fall back is to block out everything around you with music. Most phones these days come with some sort of music player But if you don't have one of these or your phone belongs to your company, the price of mp3 players keeps dropping dramatically. I've seen some for as low as $14.99. Playing the right kind of music - I don't recommend anything that regularly makes you sleepy - can keep your mind engaged and after a while you may even start typing to the beat of the music.

If a "band-aid" approach isn't helping you at all sit down and make a list of everything that needs to get done today. Sometimes having a something visual makes it easier to stay on track. Prioritize this list from MOST important to LEAST important. At the bottom of the page, write a reward. It could be anything from a small frozen yogurt to a beer with dinner to a new outfit (if your budget allows). Obviously you're going to need to be reasonable with this list - don't under schedule yourself but also don't cram so many things onto the list that you just can't possibly finish in one day - remember there's always tomorrow. As you go down your list and check things off not only will that be your production record, but it will give you a sense of accomplishment which is an automatic mood booster. At the end of the day, if you've finished your to do list - you get that reward! Not only do you have something to work towards, but there in black and white will be everything that you've accomplished that day. At the end of the day, organize your desk a little more to make sure you're flowing as efficiently as possible and then go home and make sure to go to bed on time!