Billing: Streamline those processes

Q. How can I ensure I’m maintaining accurate information in my system? 

A. Challenges in our industry continue to grow. Part of that battle is making sure that the business runs efficiently, as we continue to improve profitability for growth. To do that, streamlining our processes is the first step; staff education and direction from management are necessary. 

Intake/customer service are the gatekeepers as we emphasize the importance of accuracy, compliance and the confirmation of details from the moment we have the patient's attention. But more important is the accuracy of the data in the system. Maintenance of your business management software is confirming the data in the system is updated consistently. 

The only way to eliminate the "waste" of unnecessary touches and ineffective administrative processes is to have reliable data and know applicable requirements. Areas that play a significate role in the foundation of successful claim processing: 

Updated fee schedules 

Inaccurate information is a direct connection to the loss of revenue. The unnecessary processing time in payment application is partly due to adjustments related to inflated fee schedules and the research of possible underpayments.  

Prior authorization requirements 

Payer requirements must be confirmed for items in which an authorization is necessary to prove medical necessity. This will inevitability deter your held revenue from increasing and, without that knowledge, a delay will occur with the patient receiving their equipment. 

Modifier requirements 

Using the correct modifiers to provide the details or description of the item assists in proper payment to the provider. Without continued staff education, revenue will bottleneck and, depending on the timeframe, will become another write-off that could have been avoided. 

How can you forecast future growth if the reported data is less than accurate but more importantly, exaggerated and simply not there? Your staff's continued research and education must be ongoing to understand what is necessary to maintain a successful revenue cycle. 

Kit Shellhouse is vice president, ECS North. Reach her at kshellhouse@ecsbillingnorth.com.