billing & collections

Establishing billing and collections policies which are in compliance with federally mandated HIPAA requirements and which are cost effective to implement and maintain is certainly one of the most challenging aspects of running a successful business. Submitting claims correctly the first time is necessary to keep costs to a minimum. According to the AMA, the average resource cost for in-practice claims filings is $11.50 to $18.00 per claim. There are several basic steps practitioners may employ to reduce denials and keep billing costs to a minimum:

STEP 1: MAINTAIN CURRENT REFERENCE TOOLS

Keep a current copy of the CPT, ICD9, and HCPCS manuals. These can be purchased from:

» http://www.medicalartspress.com/
» http://www.ingenixonline.com/

STEP 2: USE A SUPERBILL

Correct use of a Superbill by the audiologist will help reduce denials. Every office needs a Superbill that contains all of the most up to date CPTs, ICD9s, and HCPCS codes; this form must be reviewed and updated annually.

Ensure you are only using CPT, ICD9 and HCPCS codes; all local codes have been eliminated under HIPAA. Ensure all necessary modifiers are used and that you note the correct place of service code.

STEP 3: STAY ON TOP OF CONTRACT GUIDELINES

Be aware of the guidelines and contract requirements of the major insurance carriers in your community, including Medicare and Medicaid.

STEP 4: USE ELECTRONIC CLAIM SUBMISSIONS

Electronic claims submission result in fewer denials as there is less human error in the claims submission process. Any practice that has ten or more full-time equivalent employees must file Medicare claims electronically per HIPAA. Medicare provides low or no cost software to providers for submitting Medicare claims. If you must file paper claims, make sure your staff is knowledgeable on how to correctly complete a HCFA-1500 form. Visit the CMS website for paper forms and instructions.

Tips for Filing Claims and Reducing Denials

• Claims should be posted each day to ensure timely filing within filing limits (typically 30-90 days; Medicare and Medicaid are often 365 days) and improve cash flow.
  • Electronic claims are typically paid within 7 to 21 days instead of the typical 30 to 60 days for paper claims submissions.
  • Paper claims often are never received by the insurance carrier and, unless you pay to send them registered mail, there is no way to track their receipt
• Claims that are unpaid after 90 days should be followed up on at least a monthly basis until a payment or a denial is received. Make sure to document all correspondence with the insurance carrier.
• Send revised claims and/or additional documentation immediately upon receipt of a denial.
• Keep all explanation of benefits forms received in your office. (It is recommended they are filed alphabetically by insurance carrier.) Keep them for at least six years.
• In an attempt to reduce write offs to bad debt and collections, have patients pay all of their out of pocket expenses (e.g. co-pays, deductibles, fees for service if they have no insurance, hearing aid related charges) at the time of service.
  • Try to reduce the amount of charges that are billed to the patient at a later time.
  • All hearing aids (unless you are waiting for some form of insurance payment) should be paid in full by the time of the fitting.
  • If they have insurance that pays for a potion of their hearing aid costs , have the patient pay the balance that is to be their responsibility at the time of the fitting; do not wait until the insurance pays; if the insurance ultimately pays too much the patient can always be refunded. [Note: Some carriers prohibit the practitioner from collecting directly from the patient – check your contract with the insurance provider.]
  • It is not in the best interest of your clinic to provide financing for hearing aids or services; you are an audiology practice, not a financial institution. Offer information for 3rd party payment plans, credit card payment, local lending institutions, etc. in lieu of in-office payment plans.
• Create a policy and/or dollar level for your practice that tells your staff when they can write off charges for non-payment. For example, you can make a rule that after non-payment for 120 days all charges under $50 are written off to non payment/bad debt.
  • Medicare co-pays should be billed at least three times before they are written off. This is not because of the actual amounts involved, but rather because you must show an earnest attempt (under Medicare regulations) to collect co-payments in order to demonstrate that you are not discounting Medicare fees.
  • Document non-payment in the patient’s records (in a place that can be seen by the practice but not by the patient or other patient’s) so, in the future, your office will be more diligent in collecting monies up front, especially in the case of all hearing aid related charges.
  • Management should monitor these write-offs on a monthly basis.
• Establish a relationship with a collections agency or appoint a staff person to make collection calls.
• Create a policy and/or dollar level for your practice that tells your staff when and/if a patient should be sent to collections.
  • Document collection status in the patient’s records (in a place that can be seen by the practice but not by the patient or other patient’s) so, in the future, your office will be more diligent in collecting monies up front or opting to not see this patient in the future, especially in the case of all hearing aid related charges.
• Clinic owners and managers must establish a chain of accountability. It is everyone's responsibility to ensure expedient and appropriate reimbursement occurs. It is vital that audiologists be active in the billing process to ensure success.

If you have any specific questions, visit the reimbursement forum or send an e-mail to the ADA Help Desk.

DISCLAIMER: The foregoing information is provided as a resource for our members. It is not intended and should not be construed as an endorsement of any of the vendors or their products or services; as such, ADA makes no warranty whatsoever, either express or implied, including the warranties of merchantability and fitness for a particular purpose regarding any of the products listed above and makes no recommendation as to the accuracy or suitability of the information for your particular situation. ADA members are encouraged to seek legal counsel to ensure compliance and are responsible for their own knowledge of both federal and state policies as it pertains to HIPAA. Neither ADA, nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including, but not limited to, any claim for costs and legal fees, arising from the use of these opinions.