It's often challenging for orthopedic and spine surgeons to stay on top of collections and cash flow at their practices. To help improve these efforts, Monty Miller, president and co-founder of Momentum Billing, discusses five best practices for effective billing processes.
1. Update practice technology. There are several technologies orthopedic practices can adopt to improve billing and collections, according to Mr. Miller. Invest in web-based programs that standardize the workflow and check the claims for errors before they are billed because the web-based programs are constantly updated. "You want to find something that is fully integrated and has the modules to run the practice," he says. These functions should include billing and collections, patient information modules, charting capabilities and a scheduling module. "You want a core technology that is really solid and then you wrap coordinated processes around it."
Practice administrators should also pay close attention to accounts receivable. If a practice has a high percentage of claims not billed or on file, the surgeons are losing money on those visits. The appropriate technology can ensure all claims are accounted for and then make sure the claims are correctly coded before leaving the office. As a technology platform for Momentum Billing and their clients, Mr. Miller uses AdvancedMD, which, in addition to the modules stated above, contains a web-based claims scrubber that checks for faulty coding combinations and incorrect data fields before the claim goes out the door.
2. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Mr. Miller. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.
3. Employ coders with knowledge of orthopedic and spine procedures. Specialty knowledge is vitally important to successfully billing for a practice. Hire coders who really understand how orthopedic and spine procedures are performed because they must recreate the procedure on the claims. In addition to receiving optimal reimbursements for surgeries, this knowledge helps the coders quickly understand errors made on denied claims, and they will learn from these mistakes, says Mr. Miller. The coders also need to stay at the forefront of the industry and have training in billing changes as they occur.
4. Invest in a good revenue cycle management company if you have trouble hiring or retaining experienced billers or have many cash management functions consolidated in a single role/person. In addition to improving billing and collections, a revenue cycle management company can help with contracting, credentialing, authorization, eligibility, claim capturing, accounts receivable and offers a level of check-and-balance to cash management that a smaller practice can not achieve because many functions are concentrated in one person, says Mr. Miller. "One of the first things you want to look for when selecting a billing partner is a company that is technology enabled, so the practice can see what the billing service is doing and you have access to regular reports on claims progress and revenue collections. Additionally, you want a firm with the business expertise and experience who can support the practice with consulting and recommendations," he says. "Having transparency is a huge aspect to the partnership." Orthopedic surgeons are often hesitant to outsource the revenue cycle management of their business, but a billing company that promotes transparency in their actions is more accountable for the success of the practice.
"Transparency builds trust and trust builds a relationship," says Mr. Miller. "It's a collaborative approach to operating the practice. Being transparent allows the surgeon or practice administrator to see what the management company sees when looking at claims."
Using web-based programs can help both parties have access to this information. Surgeons can use the program to look up claims that are billed and where denied claims are in the appeals process. The revenue cycle manager also should prepare information to understand the surgeon's payor mix, financial class mix and level of workers' compensation patients. "We look at these mixes and see how they affect the business," says Mr. Miller. "If they aren't favorable, we see what we can do to push referrals from the entities that are more profitable."
5. Employ good claims management techniques. Make sure to get clean claims out the door as quickly as possible, says Mr. Miller. "Have the processes in place to ensure you are getting clean claims out the door up front and you will see the profit at the back end," he says. Having an up-front process to check a patient's insurance coverage or eligibility is an important part of moving clean claims through swiftly. When using automation technology, the practice can have a process in place to check insurance coverage prior to the visit, which will enable the office staff to handle the patient more efficiently, especially if insurance coverage has been recently discontinued. This process will ensure faster payments through fewer denials.
When using a revenue cycle management company, be sure the company is pursuing the last 5-10 percent of the denied claims. Some billers don't manage to this degree because it isn't profitable for them because they don't use advanced claim management technologies. However, it can be crucial for the profitability of the practice, says Mr. Miller. "A good partner will exhaust all efforts to collect on claims," he says. "If a claim gets denied several times, don't let it drop off of the radar." Collecting on all claims is important to maintaining a profitable practice.
Learn more about Momentum Billing.
Read other coverage on increasing orthopedic practice profitability:
- 5 Best Business Practices for Orthopedic Practice Administrators
- 6 Ways to Increase Profitability of Your Orthopedic-Driven ASC
- 6 Techniques for Maximizing Revenue Cycles at Orthopedic Practices
1. Update practice technology. There are several technologies orthopedic practices can adopt to improve billing and collections, according to Mr. Miller. Invest in web-based programs that standardize the workflow and check the claims for errors before they are billed because the web-based programs are constantly updated. "You want to find something that is fully integrated and has the modules to run the practice," he says. These functions should include billing and collections, patient information modules, charting capabilities and a scheduling module. "You want a core technology that is really solid and then you wrap coordinated processes around it."
Practice administrators should also pay close attention to accounts receivable. If a practice has a high percentage of claims not billed or on file, the surgeons are losing money on those visits. The appropriate technology can ensure all claims are accounted for and then make sure the claims are correctly coded before leaving the office. As a technology platform for Momentum Billing and their clients, Mr. Miller uses AdvancedMD, which, in addition to the modules stated above, contains a web-based claims scrubber that checks for faulty coding combinations and incorrect data fields before the claim goes out the door.
2. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Mr. Miller. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.
3. Employ coders with knowledge of orthopedic and spine procedures. Specialty knowledge is vitally important to successfully billing for a practice. Hire coders who really understand how orthopedic and spine procedures are performed because they must recreate the procedure on the claims. In addition to receiving optimal reimbursements for surgeries, this knowledge helps the coders quickly understand errors made on denied claims, and they will learn from these mistakes, says Mr. Miller. The coders also need to stay at the forefront of the industry and have training in billing changes as they occur.
4. Invest in a good revenue cycle management company if you have trouble hiring or retaining experienced billers or have many cash management functions consolidated in a single role/person. In addition to improving billing and collections, a revenue cycle management company can help with contracting, credentialing, authorization, eligibility, claim capturing, accounts receivable and offers a level of check-and-balance to cash management that a smaller practice can not achieve because many functions are concentrated in one person, says Mr. Miller. "One of the first things you want to look for when selecting a billing partner is a company that is technology enabled, so the practice can see what the billing service is doing and you have access to regular reports on claims progress and revenue collections. Additionally, you want a firm with the business expertise and experience who can support the practice with consulting and recommendations," he says. "Having transparency is a huge aspect to the partnership." Orthopedic surgeons are often hesitant to outsource the revenue cycle management of their business, but a billing company that promotes transparency in their actions is more accountable for the success of the practice.
"Transparency builds trust and trust builds a relationship," says Mr. Miller. "It's a collaborative approach to operating the practice. Being transparent allows the surgeon or practice administrator to see what the management company sees when looking at claims."
Using web-based programs can help both parties have access to this information. Surgeons can use the program to look up claims that are billed and where denied claims are in the appeals process. The revenue cycle manager also should prepare information to understand the surgeon's payor mix, financial class mix and level of workers' compensation patients. "We look at these mixes and see how they affect the business," says Mr. Miller. "If they aren't favorable, we see what we can do to push referrals from the entities that are more profitable."
5. Employ good claims management techniques. Make sure to get clean claims out the door as quickly as possible, says Mr. Miller. "Have the processes in place to ensure you are getting clean claims out the door up front and you will see the profit at the back end," he says. Having an up-front process to check a patient's insurance coverage or eligibility is an important part of moving clean claims through swiftly. When using automation technology, the practice can have a process in place to check insurance coverage prior to the visit, which will enable the office staff to handle the patient more efficiently, especially if insurance coverage has been recently discontinued. This process will ensure faster payments through fewer denials.
When using a revenue cycle management company, be sure the company is pursuing the last 5-10 percent of the denied claims. Some billers don't manage to this degree because it isn't profitable for them because they don't use advanced claim management technologies. However, it can be crucial for the profitability of the practice, says Mr. Miller. "A good partner will exhaust all efforts to collect on claims," he says. "If a claim gets denied several times, don't let it drop off of the radar." Collecting on all claims is important to maintaining a profitable practice.
Learn more about Momentum Billing.
Read other coverage on increasing orthopedic practice profitability:
- 5 Best Business Practices for Orthopedic Practice Administrators
- 6 Ways to Increase Profitability of Your Orthopedic-Driven ASC
- 6 Techniques for Maximizing Revenue Cycles at Orthopedic Practices