Payment Posting Mistakes

payment posting mistakes

5 common payment posting mistakes!

Mistakes happen, we all know that, but a proper payment posting process is an integral component of any revenue cycle management process. Good payment posting practices should positively contribute to overall key performance indicators for an organization.

1. Failure to identify and process refunds

Quickly detect and reconcile credits to maintain real-time accounts receivable. Credit balances deflate your account receivables due. Leaving open credits can be costly when identifying claims still open on individual accounts that carry credit balances. Reconciling overpayments early in the process ensures there are no future unexpected offsets.

2. Holding EOB’s

Timely cash posting keeps your collections staff working on recovering claims that are outstanding. If there is a pattern of your account receivables department consistently researching claims that have already paid you should reconsider your process. Payments not posted promptly, adversely contributes to the DRO (days receivable outstanding). Delayed payment posting can negatively affect the key performance metrics of your collections department. These delays can lead to discouragement for your collection staff and also misunderstandings with management. Your DRO will vary by payor mix, but the principle of a low DRO still stands.

3. Delaying analysis of non-paid line items

Delaying analysis will quickly lead to additional problematic claims. When you can quickly identify a payer issue, you can resolve it before releasing other claims. It is easy to skip over a line item denial and focus on a complete claim denial. This is a recipe for unnecessary write-offs.

4. Delayed billing of secondary claims

Early reconciliation of primary payments allows you to put a process into motion which allows you to submit secondary claims quicker. Today, more secondary claims are filed electronically and the turn around times are being greatly reduced to the Medicare standard of 14 business days.

5. Delayed patient invoicing

Great lengths are taken to estimate the expected patient due amounts at the onset of each therapy to collect up front, but often subsequent patient invoicing is still required. Promptly posted payments ensure the reduction of patient write-offs.  A delayed invoice is out of sight and out of mind for the patient and you can expect they will delay your payment.

When there is a proven process for accurate and timely payment posting monthly revenues should increase. Is payment posting a challenge for your organization? If you have questions or concerns about your process or you are looking for expertise in managing your process contact PRI today for a free consultation and billing analysis?

5 Reasons for outsourcing your home infusion billing

Reasons outsourcing home infusion billing

Outsourcing may be right for you

The home infusion industry is constantly facing new challenges, from excessive regulatory changes to declining reimbursements.  Outsourcing your home infusion billing may be a solution that has crossed your mind, but you have been unable to validate your queries.  Outsourcing may be a great partnership, which may greatly benefit your company. Consider these 5 reasons to outsource your home infusion billing.

FOCUS ON YOUR BUSINESS STRENGTHS

Are you focusing on the right things? We can’t all be experts at everything, right? Home infusion billing and infusion reimbursement can be an overwhelming task if it is not your primary strength.  Spending time trying to grasp billing guidelines can be a tedious chore if it isn’t your strength. Outsourcing your home infusion billing gives you the freedom to effectively engage in your strengths, which strengthens your business overall.  

MAXIMIZE REIMBURSEMENT, MINIMIZE ERRORS

Are you seeing significant errors and lower than expected reimbursement? An experienced home infusion billing analyst is able to maximize your home infusion reimbursement by identifying coding strategies which allow for the highest reimbursement.  Errors are reduced because they are caught before they reach the payer.

AN EXPERIENCED STAFF

Difficulty finding the employees you need? A dedicated and experienced staff consisting of highly trained home infusion reimbursement analysts is your best solution to not having top-notch talent in-house or excessive staff turnovers.

PRODUCTIVITY AND PROCESSES

Unable to develop and maintain a process that works?  People don’t fail, processes do. Outsourcing your home infusion billing affords you the opportunity to access proven processes which lead to increased productivity, greater collection efforts and peace of mind.

NEW BUSINESS

New provider woes?  A new provider may have many learning curves when first starting a home infusion business. Outsourcing allows home infusion reimbursement knowledge to be at your finger tip.  It is one less burden a new provider need worry about.

 

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Insurance Verifications

Insurance Verifications

Insurance Verifications for Home Infusion Providers

Insurance Verifications that are accurate and comprehensive from the onset of therapy, contribute to quicker reimbursement turnarounds.

There are many health care providers that blindly use their clearinghouse capabilities for insurance verifications. Clearinghouses, web-based and automated insurance verification’s response systems almost never contain all the information you need to make an informed decision.  An inexperienced verifier can make costly mistakes when using these services.

Here are a few tips for successful insurance verifications.

Use a benefits insurance verification sheet.

A standardized form will ensure every pertinent question is asked.  There is no room left for assuming.

Reverify Benefits for new a new therapy.

There are many different classifications for medications and depending on the patient’s insurance carrier you may not be able to provide the service.

Always assume the customer service representative could be wrong?

Home infusion services are continually evolving.  It was not long ago that you could call an insurance company and they did not know what home infusion therapy was. Today, there are very few carriers that actually have a separate home infusion benefit.  Home infusion benefits  are often bundled into a home health benefit.  For this very reason, if something doesn’t sound correct continue to press the issue.  It is perfectly reasonable to challenge what you are being told.

Verify the benefit year.

Most major insurance plans are calendar year, but a few such as Tricare and Tricare for Life have a benefit year of 10/1-9/30.

Document customer service rep, date, time and phone number.

A well-documented call gives you the power to say the insurance, that the customer service representative quoted you an incorrect benefit.  It also gives you the power to fight and receive reimbursement for the services you rendered.

Verify the benefit category quoted.

There are many insurance companies that still do not have a separate home infusion benefit. It is always important to ask whether it is a home infusion benefit, durable medical equipment or home health benefit.  It could be a major difference in your reimbursement amount as well as if an authorization is required.

Suggested intake forms:

Noridian DMEMAC

CGS DME MAC

Have an intake challenge, ASK US!

Medicare Detailed Written Orders

Detailed Written Orders for E0781

Medicare Detailed Written Orders and Pumps

Noridian Jurisdiction D, DME MAC recently published the results of the Document Compliance Review (DCR) from April 2016 through June 2016 for procedure codes E0781 and E0784.  When a DCR occurs  Medicare will send the provider an Additional Documentation Request (ADR) letter.  

Of the 87 claims reviewed by Medicare, for E0781, 47 were denied. Based on dollars, this potentially resulted in an overall improper claim payment rate of 37%.  Results have prompted Noridian to continue the DCR.

Top Denial Reasons for the external infusion pump.

The outcome states a fact, home infusion providers are still finding difficulty in complying with documentation requirements.  A key component of the detailed written order is:

A provider cannot bill Medicare prior to receiving a signed DWO.

A home infusion provider who has billed for services prior to the signature date by the physician will result in a denied claim.

Have you struggled in your home infusion reimbursement department to effectively set up a winning strategy?  Here are a few items to consider:

  1. Have a practical process in place for obtaining and following up on a Detailed Written Orders?
  2. KISS (Keeping it Simple and Straightforward), so that anyone is able to duplicate the process during staff absences.
  3. Use the same DWO format.  Keep it uniform by using your practice management system.  Medicare’s policy states that someone other than the physician may create the DWO.

Save yourself the frustration of getting your claims denied by taking a few minutes to set up these fundamental processes in order to get it right the first time.

Have a home infusion reimbursement challenge, ASK US?