PAR OR BETTER?
Do you ever wonder why professional golfers get so upset over a small noise or unexpected gust of wind? Well, for all of us weekend hackers who simply love for our score to be lower than the temperature in August, we are not quite as bothered by the noise or wind. The skill level in our golf game is low at best; therefore, we play golf to enjoy the weather, get exercise, negotiate business, or enjoy the company of friends. Many professionals in all walks of life strive to be better par. What separates the par-shooters from those who better par? More often than not you will find that attention to detail separates the good from great and par-shooters from those who better par.
The number of Medical Coding & Billing companies to choose from is large and diverse. Some professionals that direct and manage companies are far better than others due to their attention to detail within their organization. As a billing and coding company grows, the most difficult challenge is to recruit, train, educate, and retain high-quality people who are committed to providing services that are better than par. The successful companies are led and directed by professionals who, regardless of growth, understand that the difference in more often related to service and detail rather than price. Growth is positive as long as your organizational infrastructure is developed to accommodate the growth. Conversely, growth can be a negative if growth creates lapses in service or attention to detail. Over the years, a good number of companies have experienced rapid growth that resulted in poor service, lack of attention to detail, and eventual loss of business and/or reputation.
As a physician group, you need a billing and coding company that performs better than par when it comes to attention to detail. For the purposes of this article, let's focus on three areas of detail. The first and probably most significant area is physician documentation. Most companies provide some type of documentation feedback to their physician groups. I have seen everything form elaborate reports listing revenue lost, charts downcoded, etc. to memorandums noting which doctor is having problems and what type of problems have been encountered. Personally, I would ask to see specific examples of actual deficient charts to provide as feedback. Most people are visual and tend to change behavior much better when they are provided the actual document with details as to what was deficient rather than a report of lost revenues or notes that tell you that your review of systems is short. Yes, sending chart examples is costly to the billing company; however, you pay your coding and billing vendor to provide feedback. Work wit you vendor to get the feedback in the form that works best for your group.
The second area of detail is processing of Explanation of Benefits (EOB) or Remittance Advices (RA). The EOB/RA is attached with each payment received for services rendered. The billing company posts payments to patient accounts based on these EOB's/RA's. Sounds straight forward, Right? As they say in the famous car commercial, “Not Exactly”. Many EOB's/RA's contain incorrect contractual payment amounts, inappropriate denials, and inappropriate bundling of codes. All errors/omissions are designed to reduce payments to providers. You would be surprised at the number of accounts receivable personnel that either through instruction or lack of education, simply post only what the EOB shows without appealing these inappropriate payments, bundling, etc. You should ask for exact processing details from your billing vendor to understand how they are processing your business. If your billing vendor uses the “cookie-cutter” approach that takes what is stated on the EOB as gospel, you are losing large sums of money.
The third and final area of detail is coding. Coding is the single most critical function of your billing and coding vendor. Coding directly impacts your compliance, reimbursement, and long-term viability of your group. I recommend that you have your coding audited at least once a year to verify compliance and make sure your vendor is not unnecessarily leaving money on the table due to incorrect coding. Compliance has been paramount in our industry; however, providers should be paid for the work they document. Emergency Medicine coding is very complex; therefore, you will find variances when charts are audited. As a provider, you must be certain that your coding minimizes risk and legally maximizes revenue.
With the various changes in our industry that have negatively impacted reimbursement or the costs of doing business, such as malpractice insurance premiums, physicians need billing and coding vendors who are better the par . Work closely with your vendor to make certain they are paying attention to the little details.