SEASON'S GREETINGS

And "That's a Wrap!"

By: Glen and Cheryl Sands

As the end of 2014 quickly approaches, I cannot help but focus on the start of a new year soon.  Of course, deductible season is synonymous with the thought of turning that December calendar page over.  Being on the brink of launching into 2015 does not have to leave you apprehensive if you remember the following:

 

Copay Collection - it is very important to obtain your patient's copay at the time of their appointment.  Money in hand is worth a lot these days!  You would be surprised at the number of copays that go uncollected at the date of service, and ultimately remain a liability as an uncollectable debt.   What's the old saying, "A bird in the hand is worth two in the bush."  (Yes I like to quote old sayings...sorry!)

 

High Deductible - As the insurance industry scrambles to keep up with all these changes, one trend we are definitely seeing is higher deductible amounts.  Beware, especially before you perform a surgery what the patient's insurance says about the amount of their deductible that is still unmet.  You have every right to require the patient to pay up front before the surgery.  You can always refund any amount later that was paid in excess.  If you have ever been stuck doing a huge surgery and not getting anything for your hard work due to a patient who is unable to pay a high deductible amount, you know that "Experience is the best teacher".

 

Pre-Authorization/Referral - Our advice?  Call, call and then call and double check!  We have more claims on hold pending a need for referrals or authorizations! It is very frustrating to have to wait on reimbursement for you because a referral or auth was not obtained.  Ask your staff to learn what each insurance company requires and to be tenacious in tracking down the needed information before the claim gets to SMB.  Remember - "It's no use closing the barn door after the horse is gone."

 

Information Needed - You can log in to our Simply Podiatry system and see claims that are in a status called "information needed".  These are claims that are missing something like patient's correct insurance, date of birth, street address or any number of things.  Our policy is to ask you for this info twice, then after that we give you a final reminder that we have to write off the claim if we cannot get the missing item (s).  After all - "We cannot get blood from a turnip."  We really need your cooperation in eliminating these type of delays.

 

"Tooting our Own Horn"

 

 Did you know that we call on every single claim over 30 days old once a month until the claim is paid? In addition, our policy is that we never write off anything, ever! (Without a long drawn out process and a system of checks and balances - and many, many calls, and documentation letters sent to the insurance company.)  Perhaps you have noticed we are quick in getting your claims transmitted?  We strive for 48 hour turn-around time, but usually it is even quicker than that.  Basically it boils down to "If our client ain't happy, ain't nobody happy around here!"

 

Finally, we want to hear from you, our valued client, as we want things to go smoothly for you.  It is our desire to take the billing headaches away from you.  We know that there is room for improvement at SMB Medical Billing, and we are interested in what you think.  We realize that if we approach each issue only from our perspective, we are missing a big part of the puzzle.  I mean, "You can't see the whole sky through a bamboo tube."  So we need input and suggestions from you.  Please email or call us anytime - 866-514-0380- or email us at suggestions@smbmedicalbilling.com.

 

Insufficient Documentation

By: Cheryl Sands

(Note:  Medicare issued an educational document recently to assist doctors in understanding insufficient documentation.  Here is an excerpt from the website, as well as the link you can click on to read the bulletin in its entirety.  This is provided to you so that you can understand how vitally important proper documentation is in the processing of your claims. More and more insurance companies are requesting notes, as you know.)

 

Claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed, i.e., the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary. Claims are also placed into this category when a specific documentation element that is required as a condition of payment is missing, such as a physician signature on an order, or a form that is required to be completed in its entirety.

Insufficient documentation errors identified by the CERT Review Contractor may include:

• Incomplete progress notes (e.g., unsigned, undated, insufficient detail, etc.)
• Unauthenticated medical records - no provider signature, no supervising signature, illegible signatures without a signature log or attestation to identify the signer, an electronic signature without the electronic record protocol or policy that documents the process for electronic signatures
• No documentation of intent to order services and procedures - incomplete or missing signed order or progress note describing intent for services to be provided

 

For more information please click here.

 

Employee Spotlight

Pam Birchfield, Billing Specialist

Pam Birchfield

About Me:

I have been married for 25 years to my husband Bill.  We have a daughter, Kayla, who  is a Registered Nurse.   Our son, Andrew, is attending college to earn a degree in Marketing.  As a family we enjoy cheering on the Kansas City sports teams, family vacations and just hanging out together.

 

Fun Facts:

I enjoy quilting and working on craft projects in my spare time.  Fall is my favorite time of year.  I enjoy the crisp cool weather and seeing the leaves change colors.

 

Goals:

I have been with SMB for 9 years and I love my job.  It is my goal to ensure that offices receive payment on every claim and that any denials are worked until paid.  I complete an aging report every 30 days to make certain all claims are being processed in a timely fashion.  It is my goal to offer assistance to your staff with billing questions and patient balance inquiries.  I also make it a priority to communicate any updates that come about related to the constant changes that are happening in the medical industry regarding billing.

 

From all of us here at SMB, we hope you have a wonderful holiday season and we look forward to working with you in 2015.

Sincerely,

SMB Medical Billing