Here are five mistakes orthopedic practices often make when dealing with their revenue cycle.
1. Trusting revenue cycle management to lower-level employees. Orthopedic surgeons often leave their billing and revenue cycle management to lower skill level employees, trusting them to accurately bill for services rendered. Unfortunately, such employees often are not educated about the best practices for billing and coding, and y may be leaving money on the table by submitting inaccurately coded claims or failing to go after denied claims.
"The education and skill set of the person who is controlling the revenue is huge, and these people must stay on top of industry changes," says Nancy Moore, president of NBP, a practice management support company. "We regularly see practices where 30 percent of their accounts receivable is lost money due to inaction "
2. Accepting that insurance companies are dealing with claims accurately. Insurance companies sometimes make mistakes, and they might even deny correctly coded claims. "About 12 percent of the time, the insurance company will not process the claim correctly, it should have been paid but now the only recourse is an appeal," says Ms. Moore. "If physicians aren't on top of billing issues, money can fall through the cracks and just disappear."
Orthopedic practices should also be familiar with their rates from each payor to know whether they've been receiving full reimbursement. "We know what each of our clients is to be paid from their CPTs based on the contracts with the payors," says Dave D'Silva, COO at Healthcare Information Services, a company focused on maximizing physicians' reimbursement and revenue. "When payments come in, we compare them with the provider's contract. If the payment is incorrect, we go back to the payor, show them the mistake and ask them to pay the appropriate amount." In 2010, the company recovered more than $800,000 that was improperly paid by payors.
3. Not having a process in place for denied claims. When claims are denied, orthopedic practice staff should know exactly how to deal with them. Have a process in place to locate the mistake, fix the error and then have the claim back out the door quickly so denials don't bump against filing deadlines. "In some cases, when practices receive a denial there is no activity on it because the practice hasn't staffed someone to take responsibility for denied claims," says Mr. D'Silva. "You're leaving money on the table by not fixing or appealing these claims."
Incentivize your employees to meet national benchmarks. If the staff still has trouble, you might want to consider outsourcing denied claims to achieve the best returns.
4. Only focusing on your own data during assessments. It's important for orthopedic practices to benchmark their success against other practices in their community and around the country to make sure their billing process is as successful as those of their neighbors and competitors. If your practice has a high percentage of denied claims or low levels of full reimbursement, you'll need to evaluate where big losses are and form a plan to address them.
"Orthopedic practices should perform a claims audit, it's very important to benchmark the practice against local and national peers to know where they are falling," says Ms. Moore. "Once they do the audit and benchmark the practice, periodic reviews should be conducted to ensure they stay on target. You absolutely have to stay ahead of the curve in orthopedics, and that can be problematic, especially in instances of bundled surgeries and reimbursements."
5. Not checking on patients' coverage prior to their visit. "Orthopedic surgeons should know whether their patients are covered for visits, treatments or surgeries before their initial visit at the office," says Ms. Moore. The front desk staff should check to make sure the patients have insurance and that their insurance covers all relevant services. These staff members should also address any outstanding bills from previous visits.
Read Articles Related to Revenue Cycle Management:
7 Steps to Improve the Financial Performance of Orthopedic Practices
5 Best Practices for an Effective Billing Process at Orthopedic Practices
7 Strategies to Optimize Patient Responsibility Collections for Orthopedic Practices
1. Trusting revenue cycle management to lower-level employees. Orthopedic surgeons often leave their billing and revenue cycle management to lower skill level employees, trusting them to accurately bill for services rendered. Unfortunately, such employees often are not educated about the best practices for billing and coding, and y may be leaving money on the table by submitting inaccurately coded claims or failing to go after denied claims.
"The education and skill set of the person who is controlling the revenue is huge, and these people must stay on top of industry changes," says Nancy Moore, president of NBP, a practice management support company. "We regularly see practices where 30 percent of their accounts receivable is lost money due to inaction "
2. Accepting that insurance companies are dealing with claims accurately. Insurance companies sometimes make mistakes, and they might even deny correctly coded claims. "About 12 percent of the time, the insurance company will not process the claim correctly, it should have been paid but now the only recourse is an appeal," says Ms. Moore. "If physicians aren't on top of billing issues, money can fall through the cracks and just disappear."
Orthopedic practices should also be familiar with their rates from each payor to know whether they've been receiving full reimbursement. "We know what each of our clients is to be paid from their CPTs based on the contracts with the payors," says Dave D'Silva, COO at Healthcare Information Services, a company focused on maximizing physicians' reimbursement and revenue. "When payments come in, we compare them with the provider's contract. If the payment is incorrect, we go back to the payor, show them the mistake and ask them to pay the appropriate amount." In 2010, the company recovered more than $800,000 that was improperly paid by payors.
3. Not having a process in place for denied claims. When claims are denied, orthopedic practice staff should know exactly how to deal with them. Have a process in place to locate the mistake, fix the error and then have the claim back out the door quickly so denials don't bump against filing deadlines. "In some cases, when practices receive a denial there is no activity on it because the practice hasn't staffed someone to take responsibility for denied claims," says Mr. D'Silva. "You're leaving money on the table by not fixing or appealing these claims."
Incentivize your employees to meet national benchmarks. If the staff still has trouble, you might want to consider outsourcing denied claims to achieve the best returns.
4. Only focusing on your own data during assessments. It's important for orthopedic practices to benchmark their success against other practices in their community and around the country to make sure their billing process is as successful as those of their neighbors and competitors. If your practice has a high percentage of denied claims or low levels of full reimbursement, you'll need to evaluate where big losses are and form a plan to address them.
"Orthopedic practices should perform a claims audit, it's very important to benchmark the practice against local and national peers to know where they are falling," says Ms. Moore. "Once they do the audit and benchmark the practice, periodic reviews should be conducted to ensure they stay on target. You absolutely have to stay ahead of the curve in orthopedics, and that can be problematic, especially in instances of bundled surgeries and reimbursements."
5. Not checking on patients' coverage prior to their visit. "Orthopedic surgeons should know whether their patients are covered for visits, treatments or surgeries before their initial visit at the office," says Ms. Moore. The front desk staff should check to make sure the patients have insurance and that their insurance covers all relevant services. These staff members should also address any outstanding bills from previous visits.
Read Articles Related to Revenue Cycle Management:
7 Steps to Improve the Financial Performance of Orthopedic Practices
5 Best Practices for an Effective Billing Process at Orthopedic Practices
7 Strategies to Optimize Patient Responsibility Collections for Orthopedic Practices