I have been reading several articles lately that claim facilities and practices are purchasing collection technology to improve the accounts receivables that are growing due to ever-increasing patient shares in today's healthcare payment market.  Such technologies include, but are not limited to, patient portals and mobile payment options.

You can have all the collections technology at your disposal, but the most important steps in collecting patient responsibilities do not need any technology at all. Furthermore, they don't involve patient statements.

I will be outlining steps to take to ensure your patient collections are near 100% before you even send monthly statements.  These steps can be taken by almost all provider types, almost all specialties.  Facilities and providers who see patients on an emergent basis will not always be able to follow these steps, as won't large facilities with complex services being provided, such as inpatient care.  But almost all others can.

Three-step process

Step 1:  Determine benefits and collect estimated responsbility at check-in

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We've been hearing it for quite some time, but now we have a date for when it's happening.  Beginning April 2018, CMS will issue all new Medicare cards with a "unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI)" instead of a social security number with a suffix.  All cards will be replaced by April 2019.

It will be interesting to see if any of those dates will be delayed, since every single major billing change that has occurred recently has been delayed.

This is, of course, a good thing in the electronic age of identity theft, but it's going to add challenges to billing in some offices - those for whom the provider never actually comes face-to-face with the patient before the service to ask for a copy of the Medicare card and verify the number.  Hospitalists, DME dealers, anesthesia - so many specialties and provider types only get a hospital face sheet or a referral sheet from another provider, and so many times the Medicare number is incorrect and a copy of the card is not sent over.  A great many of those accounts do include the social security number, so verification becomes possible just by adding the most common suffixes until you find the correct Medicare number.  Once that is no longer possible, I suspect CMS will not relax its rules about not giving out eligibility information with only a name and date of birth.

Read more about the change here.

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I once received a call from a provider wanting denial management consulting services.  He claimed to have "not been paid all year" and wanted me to study the accounts to determine why all his claims were being denied.

After securing proper HIPAA paperwork and gaining access to the Practice Management and Document Storage systems, I went to work.  I soon discovered that although my client did have some denial problems, the biggest problem was that the back office did not seem to understand that there are three major reasons a claim will remain on the aging receivables report:

  1. Rejection
  2. Denial
  3. Zero Paid Adjudicated Claims

Most of the items on the aging report belonged in one of those three categories.  Furthermore, the remedies taken did not always match the status, which ensured the items would never move off the aging receivables report.

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We have been too busy to post any helpful hints lately.  So to make up for it, we are running a SPECIAL!

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Taylor Consulting & Billing was established in 2005.  Since then we have served dozens of clients with billing and consulting services. For our full revenue cycle management, we specialize in the small provider who is too large to do their own billing personally, but too small to hire an in-house staff.  We will also train the small provider who has time and prefers to handle their own billing personally, such as a sole-practitioner working part-time might. We have provided consulting services to all provider sizes ranging from the sole provider working part-time to the large, multi-state medical services firm. We have multi-state experience and have worked with many Medicare MACs and DMACs and state Medicaid agencies. We are located within the United States and do not offshore any portion of our processes, as we feel that US Law applicability in other countries make offshoring a risky practice. Through the years we have spent much time mentoring colleagues just entering the profession, as well as the seasoned biller, as this professional is extremely complex and varied. The fact that it is also heavily regulated by multiple authorities, it is imperative you have the latest and most correction information available to perform your duties for your employers and clients. We have decided to share our expertise with a wider audience by starting this blog. We hope you enjoy it, learn from it, and share it. Feel free to add your comments, questions, and feedback. Happy learning!

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