Basic Registrar Job

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Like a college Registrar, she answers the key question: How much will this cost me?

Reception has a hard time as Registrar...
Privacy and concentration needed for verifying insurance
Privacy needed to discuss care and payment plans.
The one thing the Receptionist does NOT have is privacy.

The doctor can often do it. Accounts manager or clerk can often do it.
Do it quietly and in private. This is the closest thing to a sales pitch we do.

Data Registrar MUST gather

...in general
a private place to meet
Office forms and policies
Acceptable payment guidelines


....with receptionists help
proof of identity
medical history
insurance contact
Verify insurance

....with doctor's help
today's fees
treatment plan
future fees

Forms you MUST address with patient:

HIPAA

release of records TO your office.

Permission to share information with their insurance

Insurance Verified

Payment plan summary and promise to pay.

Agreement to treatment (informed consent)

Type specific documents: WC827, PIPA, referral, pre-authorisation.

The first payment.


Last pass the data off to accounts to enter into the billing system as part of the day's traffic.
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All the best to you and yours.

Account Audit Procedure

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Below is a very complete audit procedure. You don't always have to do every step, but if the step you are on is just not making sense, go back and fill in the missing steps brings clarity. In my consulting work, this is mostly what I do.

Claim Audit

How to audit summary:

• 4 preliminary steps: Which account, posting & filing backlogs, ledger clean.
  
• 4 checks: service delivered, patient co-paid, claim sent, insurance replied
• 4 results: Paid Fair, Paid Poorly, No Payment, No Answer
• 4 actions: Patient collect, re-bill, write-off, defer

Four answers only every charge on the ledger

They paid a fair amount =
Correct coding, correct claim reading, fair benefits, correct identification.
To Do: bill patient co-pay and/or write off the balance.

They paid a poor amount. =
Incorrect coding, payer misread the claim, token benefits
To Do: Analyze and correct the reason for poor payment.

Paying nothing =
Incorrect identification, insufficient proof of service, no insurance or exhausted benefits or deductible
To Do:

No EOB:
wrong insurance, lost, not billed, or too recent for payment.
To Do: call to verify coverage and billing address and claim status, send or re-send the bill, or defer action.

Insurance Review Procedure

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com

Accounts Receivable Aging

An aging report is a list of customers' accounts receivable amounts by age. The report is usually divided into columns of 30-day increments such as 0-30, 31-60, 61-90, 91-120, and 120+. It alerts management to any slow paying accounts. AR the main tool a collector uses to identify what accounts need attention and action.

Here is a sample AR report from a printer. (instead of patients, they have suppliers) It shows the key data: who owes money, how much, and when is it due. Some are simpler, some are more complex. If your computer system doesn't produce Aging Reports for you, first call your billing software tech support. AR is such a basic tool that every account management software system should have a useful one.

One warning about AR, though...

If charges, billing, payment and write-off posting are backlogged,
your Accounts Receivable and Aging will be false.
Handle your posting first.

If your patient and account filing is backlogged,
your charts and EOB's will be unlocatable.
Handle your filing first.

Now you can print and handle your AR report.

There are four main types of insurance: Group, Auto Injury, Workers' Comp, and Government. You don't have to do all of them at once every month. For example, in one office, each Tuesday I look at the AR for one type of insurance account, and rotate through the four types each month. In large or specialty practices, one type might represent most of your accounts, and take weeks to go through at first. Some types take only a few minutes to review, so double them up. Adjust your schedule and staffing to accommodate the needs of your practice.

On the day you regularly schedule to address your overdue accounts, catch up on your posting and filing, then print out the "AR by insurance type" for the types you need to review today. Printing this on reused paper is fine, since no one is going to look at it but us.

In Oregon, Insurance companies have 60 days to pay or deny a claim. Add in a little time to write up the charts, post the charges, send the claim, and get the reply, it is realistically about 75 to 90 days (11 to 13 weeks, three months) before you can even consider insurance money "overdue." The more recent stuff, you can work on it, but there's going to be a lot of "yes, we have it... we're still processing it" results that will waste your time. Adjust your schedule if your state rules are different: some states allow only a 30 days processing time. But in Oregon,

Any insurance 90+ days owing needs action.

Quick, highlight every account with 90+ days owing claims on it. Those are the ones to address.

Claim Review

Review is a short action, taking no more than 6 minutes with an account.

1) Scan the overdue account to locate the exact charges that are overdue

• a) Look at the individual account ledger.
• b) Unpaid charges are marked different ways in different software... learn yours.
• c) Find the oldest unpaid amounts and come forward in your work.
• d) Those old unpaid charges should about equal the amount overdue.

2) Each overdue charge gets a separate handling: Open the account file to see the EOBs.

• a) if it's not billed, or if you have no EOB, bill it again, or
• b) if nothing is paid at all, call to verify insurance.
  
• c) if you already re-billed, and it's overdue, no reply again, call to verify insurance.
• d) if have an EOB in reply, read the EOB, and decide what to do

3) Decide what to do and do it. The action is usually one of these:

• a) write off what you must and bill the patient what's fair now.
• b) send a corrected claim with additional data, notes, or authorizations
• c) contact the insurance to clarify their reply, then act.
• d) flag the account for a more complex handling. (this is really rather rare)

4) Write what you did so you won't needlessly repeat what you did next month.

• a) keep your notes in the patient account file.. they will help you later
• b) find where you can keep account notes in the computer billing system... and use it.
• c) Mark off your AR list that you handled this account.
• d) Use a tickler file entry for any follow up you need to do soon.
  
• e) Put away the patient file.
  

As soon as you are done with one claim review, go to the next claim on the aging list and handle it until you get to the end, and the project is done til next month. Sometimes, though, the account is too complex to sort out with a short review. Those need an Account Audit... in another article here.

If your aging list is very long and needs lots of attention - more than you can give it today or this week - target the largest accounts first and handle them. Then go for smaller accounts next time. Or target by insurance company names in order (A-M this time, N-Z next time), or by patient names. Whatever works for you.

In a few months, this job will become smaller, since you will have most claims running smoothly, with notes in the paper files, computer files and tickler file. But you will always need to do this one last step:

Schedule when to go back to this job next month.

All the best to you and yours, Gary

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com

Deciphering an Explanation of Benefits

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Reading an Explanation of Benefits

• Commonalities and Differences
• Adjustment codes
• Missing EOB

Anyone who handles payments in a chiropractic office will, sooner or later, need to look at one of those confusing insurance payment explanations and decipher it. Every insurance company has their own form and style, and wordings and reasons for what they pay...or do not pay.

They even call them different things, like "Remittance Advice", "Explanation of Benefits", "Explanation of Review", "Claim Summary"... and I'm sure they'll invent more names and styles. All they are doing is tell you what they are paying and why or why not.

Here's the trick: there are only a few real things the EOB tells you:

1. Summaries: totals, subtotals, check amounts, disclaimers.
2. Identifying data: patient and doctor names and ID's,
3. Claim data: date of service, CPT codes, billed amount.
4. Reply data: payment amounts, non-payment amounts and reason codes

Most of this is easy to figure out, except the part you most want to understand: #4
Making errors in 1, 2 or 3 are a little silly, but totally possible: confusing one patient service date for another, or a summary for a payment can slow you down. After you check those, though, here's the meat.

Since everyone has to deal with Medicare, and Medicare "Remittance Advice" forms are the most complex, we'll use Medicare as the sample:


***insert more here*****

You do not have to know all the "reason codes" that payers use. Payors don't always use codes, and when they do, they always write out what those codes mean on the explanations. While Medicare dictates a list of reason codes, Medicare payors still have to write out what those codes mean on the claim form. But here what you really need to know..

THE REASONS THAT PAYORS GIVE FOR POOR PAYMENT
RARELY TELL YOU HOW TO FIX THE CLAIM.

Insurance carriers have to follow pages and pages of rules

Insurance Key Words

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Keywords and Concepts:

• Insurance, Benefit, Premium, Payor, Underwriting
• Deductible, Co-Pay, Maximum, Out-Of-Pocket, Usual & Customary
• Benefit, Assignment of Benefits
• Provider Types: Preferred, Participating, MMO, Referral, Primary Care
  
• Primary Insurance, Secondary Insurance, Third Party Insurance
• Personal Injury, Major Medical, Worker's Comp, Group Insurance
  
• Diganosis, ICD, Procedure, CPT, Pre-existing condition,

Insurance Collections Outline

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com

Gary Shannon here.

This is a linked list of articles on Insurance Collections in this blog

These articles in outline form as of October 2010.

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Keywords and Concepts:

• Insurance, Benefit, Premium, Payor, Underwriting
• Deductible, Co-Pay, Maximum, Out-Of-Pocket, Usual & Customary
• Benefit, Assignment of Benefits
• Provider Types: Preferred, Participating, MMO, Referral, Primary Care
  
• Primary Insurance, Secondary Insurance, Third Party Insurance
• Personal Injury, Major Medical, Worker's Comp, Group Insurance
  
• Diganosis, ICD, Procedure, CPT, Preexisting condition,

Reading an Explanation of Benefits

• Commonalities and Differences
• Adjustment codes
• Missing EOB

Insurance Verifying

• Workspace: Phone, on-line.
• Key Questions
• Record Keeping

Insurance Audit

• 4 steps: service delivered, claim sent, patient co-pay, insurance benefit
• 4 results: Paid Fair, Paid Poorly, No Payment, No Answer
• 4 actions: Patient collect, re-bill, write-off, or defer

Rebilling tricks, simplest to most complex

• New Claim & Repeat Claim
• Tracer
• Corrected Claim -change in code or diagnosis
• Send additional charts and data (PIPA, WC827,
  
• Primary/Secondary EOB
• Phone call. Anti-duplicate
• Payor Recourse: Supervisor Intervention, Complaint Department, Review
  
• Other Recourse: State Complaints, Dispute Resolution, Employer Intervention,
  

All the best to you and yours.

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com