Mar 2001 Table of Contents

GETTING PAID

How to Stop Hemorrhaging Red Ink



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These nine tips will help you restore your practice’s financial health.

Fam Pract Manag. 2001 Mar;8(3):16.

If you’re working harder and smarter but your revenue still seems anemic, your practice may be suffering from some internal bleeding of red ink. You may be losing money in silent, unseen ways that adversely affect the health of your practice. Here are some suggested therapies.

1. Don’t give anything away. Some practices have the unfortunate habit of neglecting to claim everything they legally can. For example, a practice will bill for a vaccine but fail to claim the corresponding vaccine administration code or bill for administering an injection but fail to bill for the substance injected. Failing to charge for services provided is like handing out money to your patients and their insurers.

2. Code appropriately. For the services you are claiming, make sure you’re claiming exactly what you did. For example, if you code a 99213 when you actually provided and documented a 99214, you’ll have given Medicare a 36 percent discount on your services. Likewise, coding an established patient office visit, rather than a consultation, for a pre-operative evaluation requested by a surgeon will minimize your reimbursement.

3. Learn to use modifiers. Modifiers can make a big difference in your reimbursement for those insurers that recognize them. Learning to use modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is especially important. It can allow you to be paid for two E/M services done on the same day.

4. Use an up-to-date and accurate superbill. Also known as encounter forms and charge sheets, superbills serve the purpose of capturing all the charges that a practice provides and is legally entitled to. If the form is using outdated CPT and ICD-9 codes, you’re inviting claims denials and billing inefficiencies, both of which can cost your practice. Likewise, if your superbill doesn’t include commonly provided services, a place for modifiers, etc., it may be contributing to your problems.

5. Track your superbills. Does your practice have a process to ensure all superbills are accounted for each day? Superbills represent money, so losing one is losing money. Consider numbering your superbills or instituting some other method to track all superbills generated each day.

6. Keep a current CPT and ICD-9 book. A superbill, of necessity, cannot cover everything. Having access to current key references, like the CPT and ICD-9 books, is essential. The cost ($100-$150 to purchase the pair) is minimal compared to what it will cost you in denied claims if you’re using old editions. You wouldn’t dream of vaccinating your patients using an outdated immunization schedule; you shouldn’t treat the financial health of your practice any differently.

7. Don’t forget to bill the patient, especially at the time of service. This may seem obvious, but some practices simply fail to ask the patient for his or her portion of the bill. Most insurance plans have a patient cost-sharing feature, and if you don’t ask or bill the patient for it, you are unlikely to collect it. You should ask for co-payments when the patient checks in at the front desk. This approach is infinitely more cost-effective than generating and mailing a bill after the fact and will probably increase your likelihood of collecting. An added bonus of doing this is that your practice earns interest on the income in the meantime.

8. Look at your Explanations of Benefits (EOBs) before you file them. When an insurance company sends you an EOB, make sure someone takes the time to review it before it’s filed. Were all the claims paid? Were all the claims paid appropriately? If the answer to either question is no, some follow-up may be in order. Otherwise, you may be letting the insurer keep money that belongs to you.

9. Hire the best you can afford. Too many practices hire office managers and billing staff with too little experience and education in the areas for which they are responsible. The money the practice saves in salaries in the short run costs the practice far more in lost revenue in the long run.

Hopefully, your practice is financially healthy, wealthy and wise enough to be doing all of these things already. If not, consider a little self-assessment along the lines suggested. The results should pay dividends to you and your practice.

Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management.

Copyright © 2001 by the American Academy of Family Physicians.
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