Whether you outsource your billing or have a biller in your office you should be able to ask questions that always keep you in control of your company.
I have been in this business for years and have heard many excuses about not being able to get information out of your billing system and most of them are just simply not true.
Here are 3 key questions that your biller/billing company should be able to answer for you.
1. Can you show me the aged accounts receivable broken down by insurance and patient balances?
I have used up to 16 different billing systems and have not found one that does not give receivables broken down by insurance and patient.
In some systems you may have to run more than one report to get this information but, in the end, the biller should be able to provide this for you.
Knowing the patient and insurance balances will help you measure performance and set goals for your front desk and billing staff.
2. Why haven’t we been paid on accounts over 90 days old and when can we expect payment on them?
If your biller is really managing the accounts receivable, they should be able to check into each outstanding account and let you know what has been done to collect the money.
All accounts should always have a note somewhere in the system to document what has been done.
If your biller isn’t managing the accounts receivable properly, you could be leaving money on the table.
3. Are there any CPT codes that insurances aren’t paying for and being written off?
The answer should be no with maybe an exception or two for the hot/cold packs not being paid.
If there are any others, you may want to dig a bit deeper to make sure they are being billed correctly before just accepting the insurance does not cover certain codes.
Re-evaluations are the most common code written off because billers think it is not covered. This, however, is not true.
Most insurance companies do cover this code if the appropriate modifier is applied, otherwise, the denial reads that the service is bundled and will not be covered.
If your biller is not able to answer these questions, it may be time to sit down and evaluate your billing department. And yes, that does mean the billing company if you outsource.
There are so many changes in the billing world and over the years I have seen a lot of lost money because of a biller not keeping up with the new rules and regulations or following best practices for revenue cycle management.
Don’t let this happen to you!