​Do you have a fee schedule and if so, do you maintain it on a regular basis?  This is an easy step to skip, but an annual review could put some extra cash in your pocket and help you keep a better handle on how much collectible money you have outstanding.  Here are some things you should consider when creating or maintaining your fee schedule.
 
Mark up the charge amount: Did you know that most payers will not pay you more than what you charge, even if you charge less than the allowed amount?  They will accept whatever charge amount you have and adjust the difference, but they won't pay you more than you charge.  This can really cost your practice!

Allowed amounts change:  In addition to payers updating the allowed amount for services, many insurances are offering incentive based programs you may be eligible to collect a percentage over the allowed amount!  If you are basing your charge amount on the payers allowed amount you may never see the incentive money that you have earned!  Even a small percentage can add up quickly!



Create consistency:  If you aren’t sure where to start, consider setting your charge amounts based on the Medicare allowed amounts.  Using 150% of the Medicare allowed amounts is a fairly standard starting point.  Using a consistent rate to set your fees will make it easier to gauge how much of your outstanding Accounts Receivable is collectible.
 
In addition to keeping the fee schedule current, make sure to monitor Allowed Amount and Paid Amount on a monthly basis.  If you find that you are collecting the full allowed amount it’s time to increase the charge amount so you don’t leave money on the table!
 
If you need help getting started – consider working with a consultant.  At RCM Insight we offer annual fee schedule reviews.  During the month of February we will be offering 4 practices a FREE fee schedule review – visit the Contact page and choose Fee Schedule as your Area of Interest for your chance to win!

As we continue preparing for the E/M code changes in 2021 it's easy to get caught up in the reduction of clicks and adding things to the note so you get enough bullet points to meet a specific level.  However, don't overlook the fact that this is the time to make sure your documentation is up to par.

More than ever - documentation of medical necessity for an appointment will be crucial to surviving an audit down the road.  While the new rules eliminate specifics that were previously recorded, medical necessity is still a requirement.  

I know a lot of providers cringe when you talk about documentation, but I really believe the new rules will help tremendously if you (or your providers) can create a habit of simply documenting what you are thinking to make a decision.  That's it.  If you considered their hypertension when you selected a specific medication, document it.  Lay out a narrative of what happened.  Instead of clicking meaningless boxes to get your level, you simply need to document the nitty gritty.  Reviewed labs and see something that needs further testing or treatment?  Write it down so medical necessity for the next step is clearly outlined in your note.

In 2021 the challenge will be to go from clicking and copy/paste habits to ending your patient visit with a note as unique as the care you have provided to your patient in that visit.  Before settling into a potentially bad habit with documentation under the new guidelines, think about have a documentation audit.  The results will help customize training for areas of improvement.  Use the contact us page if you'd like more information!

It seems the only constant in the world of medical billing is change.  2020 definitely didn't disappoint.  While the chaos of Covid forced unexpected changes this year, 2021 has a big change that you have time to prepare for! This change is exciting as it addresses the Patients Over Paperwork initiative from CMS and the AMA has helped in hopes to eliminate "Note Bloat".  The new year will roll out changes to E/M visits - make sure that all parties are prepared for this welcomed and long overdue change to medical billing!  
 
Evaluation and management services have been long overdue for an overhaul.  The 1995/1997 guidelines were in place well before electronic medical records, and with the growth of EMR's the process to document for a specific level required a lot of tedious, unnecessary documentation.  Take a look at some of the proposed updates for E/M CPT Coding and documentation requirements!

• History & Examination While the elements of history and examination that are pertinent to a specific visit shall be recorded, they will no longer be used to 'score' the level billed.

 

• Code Selection will be based on MDM or Time!  Medical Decision Making will still utilize the CMS Table of Risk time based code selection will be simplified.

The wording and explanations for MDM are being updated to provide better explanations and concise language.  For instance, definitions will now be included to clearly identify subjective wording like Self-limited and stable, chronic illness.  The clinical examples will be removed, instead using terms that are described in a clearer definition.  We will see this same type of clarification the MDM table, for example - the 2021 guidelines will specify that the amount and/or complexity of data to be reviewed must also include analysis.

For those using time for code selection, the guidelines will give specific minute ranges rather than the generic estimate that we currently see attached to E/M codes.  Another major advantage to the codes selected based on time - it now includes non-face-to-face services!  There will also be additional add on codes in 15-minute increments if the time has been exceeded for the 99205 or 99215.

While changes are daunting, I think you will find this change to be rewarding from a documentation standpoint.  If you would like help preparing your team for these changes, RCM Insight can help.  We offer training and documentation auditing.  Contact us today for more information on how we can help!

Why do I have a balance?  The golden question every physician office staff member dreads beginning January 1st.  Unfortunately, your patients are not usually savvy on what the nuts and bolts of their contract is, and they are frustrated.  They thought their plan was good, but now they have a bill. Make sure you staff is ready and able to explain these key terms to your patients when they have questions! 

• Deductible - The deductible is the amount the patient has to pay for covered services before the insurance plan pays.  Some insurance plans will apply an office visit to the deductible, others won't. Family plans typically have an individual and family deductible. 
• Copay & Coinsurance - These are both the portion the patient will be responsible for after their deductible has been met.  Copays are a set, flat fee. Coinsurance is a set percentage that the patient will pay. 
• Max Out Of Pocket - This is the limit of what a patient will pay for covered services within a plan year.  Again, on family plans there may be an individual max and family max. 

Keep in mind, your staff will not know the details of your patients plan, nor should they be expected to!  Just being able to explain these key terms and why they show a balance will help the patient understand why they owe money and help them become better insurance plan shoppers!

If you are ready to empower your staff to dig into understanding patient responsibility, the importance of collecting it up front and learning to be comfortable asking for payment, give us a call or send an email - we are ready to help you get your staff confident and empowered!

Next week I'll be hitting the road with EZClaim to attend the AMBA (American Medical Billers Association) 2019 National Conference!  This will be a great opportunity for me to gather information on some hot topics!

I'll be working the vendor booth for EZClaim - doing some demo's of this outstanding product.  In between I'll be attending sessions on the following topics - Billing for Acupuncture and Chiropractic Care, Building a Successful Billing Company, The Importance of Auditng, Clearinghouse Failure and Submission Riswks, Value Added Services that Practices Should Consider, and Copy, Paste & Cloning: Rules vs. Opinion.

This will be a great opportunity to connect with peers - and I can't wait to see who we meet this time!  If you or your biller are planning on attending look for me at the EZClaim booth!

I've always liked numbers.  Starting out in accounting in the automotive industry I enjoyed my work, but didn't have a real passion for automotive piece prices.  After having the opportunity to stay home to raise children, I found an interest in anatomy and decided to learn about medical billing.  I enrolled with Ross Medical Education Center and found billing and coding to be the perfect fit for my interest with numbers and understanding more about the human body.  Coding encouraged my curiosity and I would often find myself researching medical diagnoses and procedures because I just wanted to know more!  Once school was done I went into my first billing job posting payments, and had my eyes opened to the reality of how many layers there are to not just billing, but full revenue cycle management.  I was shocked, but eager to learn as much as possible.  Soon I moved into a supervisory role and mastered the "back side" of billing (payment posting, follow up, patient collections).  The next role I found myself in allowed me to work with smaller provider offices and learn the full cycle of a claim.  In addition, I found myself working with provider offices to make their work flow more efficient.  At the same time I was busy working on obtaining more education and certifications through AAPC.  After working for some time as an auditor and consultant I landed a role with a software company and dug into learning as much as possible about integrations and electronic claim processing.  While I love this challenge and role, I needed to be back to helping providers.  I truly have a passion for helping providers create effective processes, collect the revenue they have deserved by educating on relevant documentation and compliance guidelines.  I am here to offer insight to the providers that help their patients every day.  

Today is our first day active and motivated to support our clients!
Thank you for visiting. 
I look forward to working with you.