December 22, 2011
In a few days 2012 will begin. December is a time when things slow down and people take vacations to go to Grandma's House to wassail and have festive fun. This is also a busy time before our staff has dreams of sugarplums and a jolly old man coming down the chimney. We're a few months into new, deleted and changed diagnosis codes and we're about to face new, deleted and changed procedure codes. There may be claims that go back to January 2011 that are unpaid or were paid incorrectly and hopefully appealed with someone following up on the appeal. Some of these claims may have strict time limits such as with Medicaid, Medicare, Tricare or contracted insurance companies.
AR Recovery: Before your staff leaves in their four wheel drive sleigh, get ready for the new year. Run insurance aging reports. Find all claims that are unpaid and were never denied. Find out why they haven't been paid. Were there requests for additional information that was never received? Were these claims received in the first place? Look at all claims sent to contracted insurance companies. Did the insurance company pay these claims in the timeframe established in the contract and were the claims paid at the agreed upon contracted rate? If not, this may be the time for the doctor to decide whether to continue to be contracted with this insurance company. You want to work towards establishing your AR with a clean slate when the New Year arrives.
Compliance This is a good time to go over your compliance plan, perform internal coding and billing audits to ensure you are in compliance with current coding and billing guidelines and you are not a candidate for audits, fraud or abuse investigations. Check to make sure that your documentation supports the claims you submitted for payment.
Contracts Review your insurance contracts. Look at each insurance company to see how they are performing. Are they paying your claims in the established timeframes, are they paying your claims at the contracted fee. Do you have unpaid claims or have you appealed incorrect payments with little or no positive responses? Are you getting an unusually large volume of refund demands? Are there loopholes in your contract that the insurance company is taking advantage of? It is always possible to renegotiate your contract and if the insurance company says no or balks, maybe you might be better to terminate the relationship. Consider a limited timeframe on your contracts instead of an evergreen contract that automatically renews.
Coding: With constant changes to codes, you should make sure your software is current and up-to-date with codes that haven't been changed, deleted or new codes added. If you use superbills, make sure those are current. Make sure you are getting ready for ICD-10 and ANSI 5010. Contact your clearinghouse and Medicare MAC regarding mandated testing requirements. If your certified coders require mandatory retesting, make sure this is scheduled so that your coders remain current. Make sure you have current coding manuals.
Debt Collection: If you are using a collection agency, review their past performance to ensure that they are doing what you expect them to do without violating any laws or placing you in jeopardy of lawsuits or complaints.
The New Year will arrive quickly. There is much to do to stay current and to keep revenue from dying and becoming uncollectible. You've worked hard to make your practice into a viable, successful business, so it takes constant vigilance and maintenance to keep it successful. If you allow a disease or injury to go untreated, it can exacerbate into something that is unhealthy and costly to treat. The same can happen to your practice. Check your practice to see who is naughty or nice. Before Santa's elves go on vacation, make sure they check to make sure no lumps of coal are placed into anyone's stocking.
Steve Verno, CMBS, CMSCS, CEMCS, CPM-MCS
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