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Over the past four years I've done probably 15 or so data conversions from one billing software to another. I have also interfaced between different EMR's and our billing software. Over the course of all this work, naturally I get to see the data involved since I have to spend a great deal of time cleaning the data as much as possible. Some of the things I see include but are not limited to:
1. Missing birthdates.
2. Missing/incorrect gender specification
3. Incorrect last names
4. Incorrect/missing diag codes
5. Missing/incorrect modifiers
6. Incomplete policy information
I could go on here but you get the point. In every interface I have done with an EMR, we have had to go to the doctor's office and train them on how to properly enter modifiers/diags/etc because the doctors were putting that information in wrong or not at all.
No insurance company is going to pay you if your data is crap.
And yet that seems to be what many doctors expect.
Give me your database and one hour with MS Access and I'm virtually certain I'll find THOUSANDS of records with some or all of the issues I listed above.
In the age long battle between carriers, providers, patients, and government perhaps it is time to start looking at things like data quality and less at who can get the most politically out of whom.
JamesNT
Regards, JamesNT
JamesNT: the stupid little 21 year old with big boobs you hired typed in 11/21/1988 instead of 11/21/1978 for a birthdate
the stupid little 21 year old with big boobs you hired typed in 11/21/1988 instead of 11/21/1978 for a birthdate
I don't quite see how "big boobs" are predictive of data entry errors.....
Margalit Gur-Arie
My brand new Blog: On Healthcare Technology
elidan: JamesNT: the stupid little 21 year old with big boobs you hired typed in 11/21/1988 instead of 11/21/1978 for a birthdate I don't quite see how "big boobs" are predictive of data entry errors.....
I was being a sexist smartass. Many doctors I have seen hire girls to work the front desk for their looks, not necessarily their intelligence.
>>The sooner you get the claims to them, the sooner you get paid. The ideal situation is to bill every day. Waiting a month is equivalent to extending them credit for a month.<<
Thanks for your feedback Margalit and I think I am going to do as you suggest and evaluate. I'm not sure that the adminstratrive company that pays the bills, adopts your premise above. I think they beat to their own drummer and stay within the law.Postage is expensive but after a few month I can decide if it is cost effective. Certainly I should bill a new patient immediately and not wait an entire month!. This payer I am referring to represents the Dockworkers (ILWU) that work our American ports. They are extremely well paid and have synonymous benefits. I can't beleive they are not electronic but that is a fact.
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
I cannot agree more with that statement. Our billing center bills out four times a day and it's automated. I know several billing centers that bill out bi-weekly or monthly. How they survive is beyond me.
James, how does my argument not "cut it?" Just try that with any bill sent to you. Maybe something is not quite correct on your phone bill. maybe they forgot you middle initial. Hmm, I won't pay until you correct it. Good luck. Don't these companies have PHONES? Cannot they, the entity that OWES the money, do something about an error. They make errors constantly, and we have to fix them too.
Basically, we are idiots for putting up with this kind of crap.
The way American MDs must bill for Services is clearly broken.
E&M codes don't reflect reality of today's patient care.
The rules private payors have created to reduce claims and efficiencies is yet another failing of Private Health Insurance.
As a doc on the outside, I find it very odd.
As a part of Health Reform, doctors working with Publicly Insured patients must have much less overhead.
email:
I am a Certified Coder and have done Medical Billing nearly 20 plus years, work at Payers, Clearinghouses, and trained on Practice Management Software.
All and many are valid points and I could add additional content but nobody like a long winded approach.
Many people have the belief that the insurance payers hold back and deny for many reasons. but Crap in Crap out is true, I used to Audit claims.
A good Billing system forces you to enter the correct data and should contain all the requirements and or have edits to fill out a HCFA or a UB, various systems are good and bad in this regard.
Some states even have clean claim laws that require the Payer to pay the claim within a certain time period.
Show me a profitable practice I will show you a highly skilled and well paid biller.
Most clean electronic claims are paid within 14 to 17 days and I have seen for my clients as early as 5 days.
I guess this did turn into a longer note than my intent., also do not forget how valuable aging reports and outstanding receiveables at certain agings must be followed up on as well.
Finally, many payers offer online entering claim information directly on their website.
As in all things there benefits to Outsource and doing your own billing as well.
I welcome any comments or criticisms, I enjoy this forum.
Norv
David B. Norvell
CEO Paradise Medical Billing and Consulting
www.medicalbillinginparadise.com
sweaner: James, how does my argument not "cut it?" Just try that with any bill sent to you. Maybe something is not quite correct on your phone bill. maybe they forgot you middle initial. Hmm, I won't pay until you correct it. Good luck. Don't these companies have PHONES? Cannot they, the entity that OWES the money, do something about an error. They make errors constantly, and we have to fix them too. Basically, we are idiots for putting up with this kind of crap.
In order to understand how your argument doesn't cut it, we have to take away the sheep's clothing you have it in and observe it in it's true form:
"The insurance companies are a bunch of asses that make mistakes all the time, so if they don't care why should I?"
I do agree that it is aggravating to fix errors made by insurance companies, but aren't you making that much more work by having to fix your own errors that you sent to them to begin with? You KNOW they aren't going to pay if you send them faulty data, so why not make sure it is correct? Otherwise, you wind up in pissing match after pissing match over why you aren't getting paid. Which one of these arguments do you have time for?
1. STUPID INSURANCE COMPANY I'VE BEEN ON HOLD FOR 20 MINUTES! PAY ME MY MONEY! Yes, I see the diag code what about it?!? Oh, wait, yeah, that diag code can't possibly go with that CPT. I supposed I'll have to refile it an start all over again. I guess if I had checked that I wouldn't have wasted all that time.
2. STUPID INSURANCE COMPANY I'VE BEEN ON HOLD FOR 20 MINUTES! PAY ME MY MONEY! Yes, I see the diag code what about it?!? Yes, that diag code goes with that CPT! I see, so it was a clerical error on your end. Nice. Check on the way? Thank you.
Following your logic, you are probably having both arguments. You barely have time for one. So why not eliminate one of those arguments by making sure your end of the equation is clean and pristine?
Furthermore, clean data means smelling like a rose come audit time. Whether you are auditing yourself or being externally audited, having your i's dotted and your t's crossed means less hassle. Your self-audits will help you accurately pinpoint areas you need to work on to increase profitability IF YOUR DATA IS CLEAN AND RELIABLE. Regarding external audits, you better extend your ability to stay out of court IF YOUR DATA IS CLEAN AND RELIABLE.
Yes, the insurance companies are a pain in the butt, but they do pay - as long as your data is correct. So why send in garbage when you know what the outcome will be?
DrMurdoch: The way American MDs must bill for Services is clearly broken. E&M codes don't reflect reality of today's patient care. The rules private payors have created to reduce claims and efficiencies is yet another failing of Private Health Insurance. As a doc on the outside, I find it very odd. As a part of Health Reform, doctors working with Publicly Insured patients must have much less overhead.
So how are things in the Ivory Tower, Murdoch?
Ivory Tower ?
I'm a front line Primary Care MD.
That's not the Ivory Tower.
Substantially reducing the overhead of doctors whom provide care for Medicare patients and Publicly insured patients is a great way of maintaining or improving doctor income yet not raising the cost of care.
Actually I take that back, Canada is kind of like the Ivory Tower vs. the US. Right you are.
DrMurdoch:Canada is kind of like the Ivory Tower vs. the US. Right you are.
Jason was it you that said you get paid $30 per visit per patient and to a max per year per patient of $300? If that were true how will it be possible to manage my Geriatric cases with 10 to as many as 20 problems?
Do I handle them in 10 visits?
What about the calls? I get to sometimes manage cases over the phone weekly for free here and I get it back on complexity on CPT codes
I hope we drop these codes and get rid of AMA's cash cow. 300 mil a year as 80% of their revenue? No wonder they would not care if we are members or not. Talking about conflict of interest.
To get Primary Care MDs on board reform .... the .gov is going to have to pay the doctors more. Full Stop.
I am sure elderly Primary Care is woefully underfunded.
How do things work here.... well the "new" system is this:
In any new patient you accept you choose if you will be paid the old way or the new way.
the old way is fee for service. essentially $30-50/ visit. Usually $30.
the new way is "capitated" where you get paid per age/gender of patient.
Forinstance, I get $60/year for a 25 year old male and $500/year for my 92 year old female.
This system encourages telephone calls and other methods of managing patients besides just bringing them back to the office for countless less than medically necessary visits.
I don't know the numbers that would work in the US.
If I was to provide a rough estimate of what Obama should do ... I would aim to get you a minimum 25% take home pay increase overall. Probably more for you with your larger number of elderly patients. If you got together with 2 other doctors, formed a group, I'd throw in 1 free nurse and 1/2 social worker.
This model of care in Ontario is called Family Health Teams.
They use basically the same system in the UK.
athenahealth takes care of all those things described above. That's one of the major benefits of our embedded rules engine (patented), literally when a client types in Tom Napp, it'll check with my insurance and it will be highlighted (in real time) that my insurance company says my demographics do not match what the receptionist put in, it will actually show them that the payer has my name as Thomas Natt. The receptionist can fix it and problem solved. If they don't do that, when I come in for my appointment it will alert them again. If they ignore it again, it will be put into a "hold" status prior to being sent out until someone takes care of the issue.
Give us your mistyped/incorrectly entered birthdates, insurance card numbers, first or last names, and incorrect policy information... we'll give you a clean claim!!!!
We do the same with modifiers, diagnosis codes, bundling, etc..
http://athenahealth.com/our-services/athenaCollector.php#/Rules-Database is a video that describes the methodology behind the rules engine.
We also do Instant Adjudication with certain payers, that eliminates these issues as well. Literally while the patient is in the office you submit the claim and get an EOB on your screen within seconds. Talk about the best way to eliminate self-pay, if a patient has a deductible just swipe their credit card on the way out.
Thomas Natt, East Coast Sales Manager, SGS, athenahealth, 617-402-1237, tnatt@athenahealth.com
Disclaimer- I work for athenahealth, the views expressed are my own and do not represent the thoughts or opinions of athenahealth.
"No insurance company is going to pay you if your data is crap."
Along with many, many other reasons.
How about this Mr. Insurance company ....
"Doctor visit - sore throat. - 40$"
"How would you like to pay, Mrs. Jones?"
"No, we have stopped contracting with insurance companies."
"No, we cannot fill out any forms. Here is a copy of the note from your visit."
"I understand. They wouldn't pay us either."
"Two twenties will be fine."
"I am a Certified Coder and have done Medical Billing nearly 20 plus years, work at Payers, Clearinghouses, and trained on Practice Management Software."
And you are worth your weight in gold to any medical practice!
The point that most of would make is simple:
Lawyers don't need "certified coders" to get paid. Auto mechanics don't. Plumber's don't. Etc.
Oh, yeah - veterinarians don't!
Try not paying your veterinarian because they misspelled your cat's name on the bill.
By the way - go into any veterinarian in your neighborhood. They will have an electronic medical record!
Yup! They are not waiting for the government bailout or the perfect EMR to arrive.
They can also afford it because they get PAID!