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Tag Archives: Billing

Bolster billing compliance: Implement a Medicare Part A triple-check process

Bolster billing compliance: Implement a Medicare Part A triple-check process

Medicare billing is a domain rife with payer offshoots and evolving regulations that can be difficult to navigate without a strategy to weather claim scrutiny and withstand the gaze of CMS’ various auditing contractors.

Enter the triple-check process, a time-tested internal auditing strategy used by proactive long-term care providers to facilitate billing accuracy and compliance the first time a UB-04 claim form is submitted. As its name suggests, triple check is a layered verification process that involves staff members from billing, nursing, and therapy departments?the three core disciplines required to submit a clean claim. But this sturdy foundation is also pliable, allowing a facility to easily adapt the procedure to the various types of claims it files.

Read on for an expert iteration of the triple-check process, which is modified from the HCPro book The Medicare Billing Manual for Long-Term Care, written by Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC. This specific triple-check procedure is designed to mobilize key staff to ensure accuracy and timely submission of Part A claims.

 

Procedure

Each month, the SNF will collect all Medicare Part A billing information ready for submission and enlist the following individuals to carry out their designated roles in verifying the accuracy of these items: administrator, director of nursing, MDS coordinator, facility rehab director or designee, business office manager, medical records personnel, and central supply staff.

The following is a breakdown of each of these staff members’ responsibilities in the triple-check process:

Business office manager and medical records personnel

  • Verify that the qualifying stay information recorded on the UB-04 aligns with that on the medical records face sheet.

 

Business office manager

  • Verify that each resident has benefit days available in the HIPAA Eligibility Transaction System.
  • Verify the admit date on the UB-04 aligns with the date in the manual census log.
  • Verify covered service dates listed on the UB-04 align with those in the Medicare and manual census logs.
  • Verify that a resident’s financial file contains a signed and completed Medicare Secondary Payer form whenever applicable.

 

Business office manager and MDS coordinator

  • Verify that ADLs are correct and are supported by documentation. Confirm that staff have coded all other contributory items (e.g., mood, IVs).
  • Verify that ARDs on each MDS align with the occurrence dates found at form locators (FL) 31?34 on the UB-04.
  • Verify that the RUG level listed on each MDS aligns with that found at FL 44 on the UB-04.
  • Verify that the assessment type for each MDS aligns with the modifier found at FL 44 on the UB-04.
  • Verify that the number of accommodation units listed on the UB-04 aligns with the assessment type for each MDS. Verify that the total number of accommodation units aligns with corresponding covered service dates.

 

Facility rehab director, MDS coordinator, and business office manager

  • Verify that physical therapy minutes listed on the daily treatment grid align with those noted in the service log. Align the days and minutes documented in the MDS with those on the treatment grid. Align the number of units billed on the UB-04 with those in the service log.
  • Verify that each principal diagnosis is accurate, that all secondary diagnoses support skilled care, and that every ICD-9 code corresponds to an appropriate diagnosis.
  • Verify that occupational therapy minutes recorded on the daily treatment grid align with those in the service log. Align the days and minutes in the MDS with those on the treatment grid. Align the number of units billed on the UB-04 with those in the service log.
  • Verify that speech therapy minutes listed on the daily treatment grid align with those noted in the service log. Align the days and minutes in the MDS with those on the treatment grid. Align the number of units billed on the UB-04 with those in the service log.

 

DON and medical records personnel

  • Verify each resident’s need for Medicare skilled intervention by reviewing supporting clinical documentation that corresponds with the dates of service listed in the manual census log.
  • Verify that each (re)certification form has been completed and signed by the appropriate physician.
  • Verify that each physician order has been obtained and implemented.
  • Verify that each chart reflects appropriate charting guidelines. Confirm that charting has been completed at least once in every 24-hour period, relates to skilled service provided, and supports therapy.

 

Facility rehab director

  • Verify that physician orders include rehabilitation.
  • Verify that each evaluation notes the prior level of function.
  • Verify that clinical documentation contains a progress note establishing the need for continued skilled intervention.

 

Administrator

  • Chair the triple-check meeting (detailed below), and ensure that the entire process is completed by appropriate staff each month before Medicare claims are submitted. Participation in the triple check will allow the administrator to monitor the effectiveness of key operational processes carried out by the facility’s ­interdisciplinary team (IDT) on an ongoing basis.

Triple-check meeting and audit tool

Each of the SNF’s triple-check participants should complete their respective duties prior to the Medicare triple-check meeting, which will be held monthly before the SNF bills for a given batch of services. In other words, the meeting is not an occasion for staff to complete their initial claim component(s). Instead, it’s a chance for IDT members to cross-check the work of their colleagues by verifying the accuracy of claim items that others have completed, thereby ensuring each element has been studied by multiple sets of eyes.

The triple-check meeting will also serve as the platform for the SNF’s business office manager to document the completion of each integral item on a billing claim using the triple-check audit tool, an internal checklist-type document that will be included in every month-end closing report.

Using this audit tool, the manager will denote items verified as correct during the triple-check meeting with an "X." He or she will mark items identified as incorrect with an "O" and, in the remarks section of the document, record the steps the team will take to obtain the correct information. Items initially found to be incorrect but rectified during the meeting should still be marked with an "O" to better track any practice patterns that could lead to billing slipups and inform future training activities.

The business office manager will call for any claim found to have errors during the triple-check meeting to be put on hold until it is amended. Once staff have made necessary revisions, the manager will indicate these correction(s) and the corresponding date(s) in the remarks section of the audit tool. He or she will then contact a corporate entity to review the changes and ultimately grant approval to submit the claim.

HCPro.com – Billing Alert for Long-Term Care

Are Your Medical Billing Mistakes Costing Your Patients?

The low estimate on medical billing errors is $ 17 billion, according to a report from the Institute of Medicine. Even if the $ 29 billion they state as the top of the range is an overstatement, do you have your share of $ 17 billion to give back to patients and insurance companies? Furthermore, do you even want a part of the 250,000 patients who die each year because of medical errors (according to the medical journal BMJ) on your conscience?


Improving Medical Billing for Practices

7 Benefits of Outsourcing Your Medical Billing with ICD-10

It can be difficult deciding whether to outsource your medical billing or not. With ICD-10 coming in October, There are many benefits of outsourcing your revenue cycle functions. Let’s take a look at 7 of those benefits.

 
#1 Economy of Scale
A billing service will distribute their expenses through their complete client base, which provide an economy of scale. They are able to operate with lowers costs than what a single practice can and those savings are passed on to their clients, making them very competitive. A billing service is able to afford to hire top-notch staff so you are able to pay less and get more.

 

#2 Highly Trained Dedicated Specialists
The outsourcing team has just one purpose – its focus is to increase your practice’s profitability. They will review and post payments from the carriers to ensure that you are getting the correct amount and preventing adjustments that are incorrect. Every claim that’s outstanding will be tracked until it is paid in full. The team that handles all elements of your medical billing is the same staff to ensure cohesion.

 

#3 Gain Control
There’s a mistaken assumption that if you outsource your medical billing you will give up control. In fact, quite the opposite is true. You tend to gain more control. You have a team of dedicate professionals that are taking care of this consuming task. They have the headache of dealing with monthly reports and ensuring that payments are forthcoming in a timely manner and that billing is carried out correctly and with complete transparency.

 

#4 An Industry That’s Changing
The landscape of healthcare itself is rapidly changing and medical billing has been dragged into the middle of this upheaval. Keeping up with all the changes in the requirements and rules can be difficult. It requires continuous learning. The delete and added CPT codes come out years. Carrier rules and fee changes occur almost daily. Most people simply do not have the necessary time to dedicate to this continuous learning curve. Outsourcing to a team of professionals is very helpful.

 

#5 Get Paid Faster
Cash flow is the key to your successful practice. Accounts receivable collections have a significant impact on your revenue and your bottom line. This is where outsourcing your medical billing can be beneficial allowing for claims to be submitted faster and with fewer errors. That means you’ll receive your payments in shorter period of time. By outsourcing, you have a team of professionals that all billing to be carried out in a timely manner, and the turnaround time can be significantly reduced.

 

#6 Focus on What You do Best
You spent so many years going to university to become a doctor so that you can help people. The little free time you have, you probably hate spending on the intricacy of medical billing or maybe you hate having people on staff that cost you a fortune. A better option is outsourcing, where you get a team of professionals at a much lower cost than having your own staff.

 

#7 Reduced Stress and Increased Cash
A top-notch billing service will charge a percentage for collecting the money but compared to having to run your own billing office and staff it the fee is really quite nominal. You are suddenly getting the highest rate of return from your carriers, which means that you have more disposable income. Almost all practices that outsource their medical billing see an increase in their revenue and a decrease in their billing costs.

 

ICD-10 is complicated and the number of codes is rising from 13,000 to 68,000. That’s huge! This is going to lead to a significant increase in the number of payer denials and it is expected that there will be a decrease in cycle time. Outsourcing is a great way to save you time and money learning all of the new ICD-10 codes leaving it to a team of well trained professionals.

The post 7 Benefits of Outsourcing Your Medical Billing with ICD-10 appeared first on Outsource Management Group, LLC..

Outsourcing – Outsource Management Group, LLC.

Is It Time to Outsource Your Medical Billing?

If you are noticing your medical billing claims are taking longer and longer to be reimbursed or you are having denials, rejections, or only partial reimbursements on your medical billing claims, it may be time to look at outsourcing your medical billing claims. You may feel as though you would be giving up control of your cash flow when actually you will have more control than ever. In fact, outsourcing your medical billing and coding needs through a medical billing partner is one of the smartest business moves you can make.

The best company to handle your medical billing isn’t necessarily located around the corner from your practice or even in the same town. Thanks to the power of the Internet, secure Internet connections, and advances in software and computer networks that allow for secure transmission of sensitive data, the process of finding a medical billing company to handle your needs is just a mouse click away.

This will free up your staff immensely as they will no longer have to spend long hours at the copy machine getting claims ready to send in. Your claims will be transmitted computer to computer via secure network transmissions and you can get real-time information on your patient accounts at anytime. Furthermore, outsourcing your medical billing will insure that all your claims are properly coded and documented properly. Your medical billing partner can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and you can concentrate on growing your practice.

The post Is It Time to Outsource Your Medical Billing? appeared first on Outsource Management Group, LLC..

Outsourcing – Outsource Management Group, LLC.

Hydration Billing Question

I have a hydration billing question that I just can’t seem to find definitive guidance on….

Lets say we have a patient that’s comes in and the records reads along these lines:

Saline 1000MG 0900am-125

Other drug (any kind of chemo) 0932-1032

other drug (A therapeutic drug) 1033-1245

Here is how I have been billing: Other drug (chemo) 0932-1032=60 min =96413
Other drug (therapeutic) 1033-1245=2.12 =96367 and 96366
Hydration= 09-932=.31 + 1245-125+.40 = 1.11 =96361

Is this correct or would each chunk of hydration stand on it’s own making the correct billing 96361X2???

Please Help!

Medical Billing and Coding Forum – Hematology/Oncology

Frequently Asked Questions for Medical Coding and Billing Students

Hello Professional Medical Coding and Billing Students! Here are some frequently asked questions and their answers to your program: Q: How do I navigate to the next module? A: The Program Modules navigation tool is on the left side of each page in the program. • Click the plus sign (+) to view the list of modules in the program. • Click the module name to navigate to the first page of that module. Use this menu each time you navigate from one module to the next. Refer to the Program Navigation unit of the Program Orientation module for more…
Career Step Coding and Billing Blog

Best Practices in Radiology Patient Billing

 Maximizing the patient experience is no longer limited to the achievement of clinical success. It is a critical component of the new, broader partnership between provider and patient – one that now encompasses conversations regarding not only service quality and cost, but also places a greater focus on practice billing processes in line with the higher demands inherent to the new patient consumerism trend.  

 


Radiology Billing and Coding Blog

How to Work From Home Doing Medical Billing and Coding!

If you’re thinking about doing medical billing and coding and working from home there are a few things you want to know. First of all do you have the ability or skills or training in order to be able to process claims for doctors, dentists or large clinics.

To process claims at home you’ll either have to be in business for yourself or make some arrangement with your employers to work at home. The employer in this case would be the doctor, dentist or other health professional or clinic that needs medical billing service. This may be difficult to do if you haven’t had the proper training and don’t have the right medical billing software.

Many people who do work from home doing medical billing and/or coding generally have their own business. They have started home businesses after getting the right training. (Coding requires separate training and certification may be required by some employers.)

It would probably be difficult to get on-the-job training and more than likely you’ll have to get training through online courses, programs or schools or on campus locally where you live. There is a national exam for certification as a Medical Billing Specialist that would probably be required by most companies seeking your service. Plus after you get some training you’ll want on-the-job experience so you can learn the ropes. You want to know what you’re doing before you work alone at home.

So one of the things you can do is call some of the clinics in your area and find out whether they do their medical billing and coding in-house or whether they send it out to a billing service. If they do it in-house, ask if they hire people to do additional billing for them at home either by contracting out to you or hiring you to work at home and they would act as employer. There may be a lot of variation in practices in different geographical areas. So best to call and see what you can find out.

So now you may know a little bit more about whether you want to work from home doing medical billing and coding. When you do decide that you do need some training, there is federal government money available for online courses as well as on-campus. So you want to check out medical billing training online and local colleges. Be careful of any scams that may be operating. Read the fine print and don’t sign up for any courses you don’t need.

For secrets and tips on how to start a medical billing business or as a career, choosing the best medical billing training, finding the best medical billing business schools, online courses, college, work at home and financing go to a nurse’s website: http://www.MedicalBillingTrainingInfo.com