Holes in Your Physician Billing: 4 More to Fix

Brice Voithofer

We are pleased to present Part II in our series highlighting effective ways to fix holes in your physician billing. In Part I “Fix Holes in Your Physician Billing: Money Matters”, we described how to “plug” four holes that often lead to revenue loss. In Part II, we provide tips to plug 4 more holes that will help physicians collect all money due for services rendered.

1. The Sound of Silence: What happens when nothing comes back after a claim is filed? You don’t get a denial or an underpayment – or, for that matter, anything at all. You need a way to get an alert for each claim that winds up in a black hole – and a system to promptly forward that claim to the appropriate specialist who can quickly address the issue. Simply put, you need an automatic checking tool, to ensure that every claim is accounted for in the system – even those that are not responded to by the payer.

AdvantEdge’s technology flags claims that are overdue – and never responded to by the payer. These claims are treated as denials, and are quickly forwarded to the appropriate specialist who can address and resolve the status of MIA claims. 

2. Don’t Settle for Less: It’s important to flag underpayments because even small underpayments translate into significant losses over time. A $2 underpayment per claim can easily add up to considerable losses over a few months. That’s why it’s essential for a medical billing company to have the capacity to compare payments to contractual amounts and identify underpayments in a timely fashion. This is particularly important when a payer has the wrong amount in their system and the pattern can be highlighted for them to correct.

The AdvantEdge Virtual Manager system has the intelligence to recognize underpayments and flag them as if they were denials, so the matter is promptly addressed and resolved by the appropriate specialists. 

3. Why It’s Necessary: In cases of medical necessity denials, it’s essential to look at exactly why the claims were denied. Consider DEXA scans as an example. Radiologists may receive ongoing denials saying they are not meeting the definition for medical necessity for this service. What that often really means is that there was not a payable diagnosis code. In such cases, the billing company needs to educate physicians about medical necessity for that service so that they can provide appropriate documentation and/or help educate referring providers. 

When medical necessity denial trends are spotted, AdvantEdge promptly reaches out to providers to explain exactly what needs to be documented. This way, the root cause can be reviewed, addressed, and resolved.

4. New & Noteworthy: Changes to medical billing, including new coding requirements; coverage additions and deletions; and other regulatory changes are inevitable. That’s why it’s important for a medical billing company to keep up with current rules and regulations – and promptly inform their clients of these changes and how they can impact their bottom line. For example: The rules for colorectal cancer screenings are changing. Beginning in 2022, the removal of polyps during this procedure will change what used to be a screening test to a diagnostic test, meaning coinsurance will be required if polyps are removed. Promptly notifying providers of changes like this allows them to better communicate changes to their patients, as well as update their documentation templates.

AdvantEdge specialists constantly monitor industry changes, participate in industry and specialty associations, and immediately reach out to all providers impacted by changes in regulations and processes. Our goal is to give providers ample time to make all appropriate preparations for changes in the healthcare ecosystem.

Following these 4 tips of fixing holes in your physician billing, and the 4 tips featured in Part I of this series, puts providers in an optimal position to collect more money faster – without leaving money on the table. For more information on AdvantEdge, visit www.ahsrcm or contact us at 877-501-1611 or [email protected]. 

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