Monox Blog

Anesthesia Billing Metrics

It is undeniable,  as Americans we are obsessed with speed.  How fast is your car, how fast is your computer, even how fast is our food.  Which is why i can completely understand the obsession with speed of collections.  However a word of caution when judging the performance of your anesthesia billing company.  Speed does not always equal quality.  If you are looking for a good meal, it is not always the fastest.  Overnight claim submission.  Overnight claim submission.  While it is possible to speed through every claim, or send them out of the country, it may be wiser to have a claim touched by multiple people and double checked before initial submission.  We all know the old carpenters addage "measure twice, cut once"  This is also true with anesthesia billing.  Check twice, submit once.  One problem with speed metrics is that often times they can lead to unwanted behaviors.  Sloppy claim submission and writeoff's of collectable accounts to get them off the books.  The bottom line is, some accounts are problem accounts, period.  I am not saying that days in A/R and percentage of collections over 90 days are not good things to monitor.  Just do not monitor them in a Vacuum.  You must have a way of measuring Quality along with speed.  I can tell you from experience that the only way to measure quality is by looking at account activity.  A regular random audit of 10 of your older accounts as well as 10 accounts that were written off to bad debt is a must.  You should ask these questions.  What is the date gap between activity on these accounts, and also what is the quality of the action taken on the account?  Because if an account is worked regularly, with quality actions, there is one metric that I can guarantee will increase.  Your bottom line. 

Monox Billing Services Mactober Fest Highlights

The Palmetto Medicare conference, Mactoberfest, took place in sunny Palm Springs, California this year. Monox Billing services was in attendance to stay on top of the ever changing government regulation.  We thought we might share some of the more interesting statistics, as well as some of the event highlights in our next few blog posts.  One thing that was made apparrent was the proposed crack down on fraudulent billing.   In lieu of the recent economic trends it was reported that an estimated 12.4% of government funds, approximately 46 billion dollars, is paid annually on fraudulent or erroneously billed claims. It was announced that Obama intends to have this percentage halved by next year through prevention and detection rather than a “pay and chase” policy Medicare has been using. Working in anesthesia billing, we knew that this was really half the story.  Billing services who have dealt with Palmetto know the difficulty involved in getting setup, getting clear answers, and solving issues.  The level of frustration of attendees was obvious when the entire audience clapped as someone questioned the integrity of the Palmetto Customer Service Staff due to their policy of not being able to reveal the correct billing technique when approached with billing errors.

Anesthesia Billing Codes - Will This code pay?

When I started working in the medical billing industry,  I learned very quickly that insurance companies are not all alike. Insurance companies differ greatly in the way they process and pay specific procedure codes. My experience ranges from billing anesthesia to heart surgeon billing, and in all cases, there was a huge variance in payment processing.  In the beginning  I would receive prompt payments from insurance company “A,” without any problems, whereas with insurance company “B,” I would receive denials even though both insurance claims had the same diagnosis and the same procedures. I didn’t see it at first, but I soon started to recognize and document the patterns associated with insurance company denials on these claims.  

This wild fluctuation in payable codes, leaves doctors and billing staff in a constant state of confusion.  This company says its inclusive, this company pays it as a seperate procedure, and this company says it's not necessary.  At Monox we have developed a database filled with codes, denials, and insurance company responses.  We have leveraged this to help you determine whether a specific insurance company will pay a specific code.

            To know if a code is payable or if there is a “better” code to use and what that code should pay ask the coding experts.

 

 

 

 

By

Michael Polese

Marketing Your Anesthesia Group

How do we increase our case load, and increase our revenue?  How do we expand our coverage to nearby hospitals and surgery centers?  How doe we maximize reimbursement on our anesthesia billing cases?

While these are all very important questions,  there are few items that need to be answered first.  

Who is my customer, and what do they want?

They are two simple questions, but you would be amazed how many people get it wrong.    Knowing these key pieces of information gives you power to create powerful and lasting competitive advantages.  This information will lead to increased opportunnity and eventually the ability to demand a premium for your services. 

In the world of Anesthesia services, while delivering quality care to the patient is the top priority for any anesthesia group, with a few exceptions, the customer is usually the surgeons or hospital administration.  Knowing this greatly effects the message that your are supplying and helps to determine your points of differentiation in the market place.

Anesthesia Group Formation

Forming an anesthesia group can be a daunting task.  Especially if you are new to the business aspect of anesthesia.  The uncertainty inherant in the process can overwhelm you with the sheer volume of details involved.  i.e.  corporate stucture, unit pooling, selecting anesthesia billing services... and on and on.  In this whirlwind of detail oriented tasks, it is easy to lose track of the big picture.  For this reason, it is important to ask yourself at the outset, what is the purpose for forming an anesthesia group? 

Creating The Vision:  Imagine you stepped into a taxi cab, and the driver asks, "where to?"  If you can not answer that simple question, your going to spend a lot of money on a cab ride, and end up driving in circles.  Creating a shared vision among your partnership and establishing where you would like to take your company is an obvious and crucial first step to actually getting there. 

Creating The Motivation: Once you understand where it is that you would like to go, it is important to understand what resources might take you there.  These resources are made up of manpower, sweat equity, and knowledge.  Even more than that, they are made up of beliefs, values, and motivating factors which should be clearly and concisely laid out.  It is important to understand our strengths and how to best leverage these to reach our destination.

Developing The Road Map:  Once we know who we are and where we would like to go, it is time to draw a map to our destination.  I can tell you from experience that every group is different, and therefore the steps you will take to form a successful group will not always look the same.  That being said, there are many similarities, and you may want to draw on some experience at this point.  At Monox we develop a step by step roadmap for your group with timelines, action items, and goals.  We also take the time to ensure that these action items tie into your overall strategy as a group.  

Taking Action:  Once the road map is developed, it is time to execute.  Many physicians find that practicing medicine, maintaining a personal life, and tending to the administrative tasks necessary for group formation is too much.  At Monox we not only form an action plan, we execute.  

Anesthesia Billing Services helping the patient

This morning I had a very rewarding experience that left me feeling proud of the Anesthesia Billing work I was doing here at Monox. A few weeks ago I received a phone call from a patient's husband regarding emergency medical services for his wife. After verifying who I was speaking with, I asked the patients spouse how I could help him. The patient's spouse stated he received a Final Notice that this account would be sent to agency if immediate action is not taken. I explained to the spouse that medicare has denied this claim multiple times and have also denied our appeal and he would be responsible for the balance. What happened next was something I had not experienced before as the husband broke down emotionally and begin to sob uncontrollably. I knew this wasn't a typical reaction to a medicare denial so I asked the husband if there was anything I could do for him. The husband took a few moments to respond and then began to relive the evening that his wife was taken in for emergency medical service. I listened while the husband told me, in detail, the events leading up to that emergency room visit. I remember the husband saying that he and his wife spent the whole day together and it was a wonderful day, but towards the end of the day his wife said she felt like something was very wrong with her so they called 911. As soon as they arrived to the hospital the husband was told his wife needed to undergo emergency surgery but the outcome of the surgery was very favorable.

 

I remember the husband repeating, almost as if he was in a trance, "everything was happening so fast." The husband stated he gave his wife a kiss and told her he loved her and they wheeled her back to the operating room. That night, during surgery, there were complications and his wife died. I listened while this gentleman struggled to regain control and when he spoke his next few words, I could feel his sadness and hopelessness. I told this gentleman he was a great husband and his wife was lucky to have him for as long as she did and the husband spoke a very soft "thank you" before hanging up the phone.

After hanging up the phone, a feeling of sadness coursed through my body. This feeling I had inside me was so strong it was hard for me to focus on my work so I went to my supervisor for counsel. I told my supervisor about the phone call and how I felt bad for this gentleman and that I wish I could do something to help him. My supervisor quickly responded saying that if I wanted to help this gentleman out then to get medicare to pay his bill. I explained that I have tried many different ways to get this paid, but medicare continues to deny this claim and now the account is very delinquent. My supervisor suggested I try one last time to get this claim paid but to remind myself of the importance of this particular claim. After numerous phone calls to medicare the claim finally got paid. After applying the payment, I called the husband and left a voicemail informing him that we were able to get medicare to pay and his small coinsurance responsibility was written off by the doctor so that account was now at a 0 balance. The next morning, the first call I received was from the husband, who sounded happy and calm, and all he said was, "Michael, thank you for everything you have done for me and my wife, you will be in my prayers."  

 

By Michael Polese

How Aggressive Is Your Anesthesia Billing Company

How aggressive your anesthesia billing company is, will reflect immediately on your bottom line.

Make sure that your anesthesia billing company has an aggressive billing account receivables follow up process. Any good billing company will send you weekly, monthly and annual aging reports. These reports should reflect the correct mix of profits, loss of revenue, insurance adjustments and timely payments.

A lot of billing companies do "soft collections". There should be a blend of the soft and the tough approach. If you have a patient base that needs a stronger approach, consider asking them for "alerts" so that you can give approvals on a more aggressive approach to certain accounts if need be. Choose a company that has a more creative and cost-efficient method of working the claims for better effectiveness and thereby getting  results that will add to your bottom line.

Receivables tend to have a pyramid pattern, where the money flows in easily at the bottom of the pyramid and becomes increasingly harder as we move to the top. In fact they are more routine in nature, but it is the top of the pyramid that has the "difficult" dollars and your billing company must know how to collect on these.

This is what truely defines a good billing company. A company that has the know-how and the experience to tap into these "difficult" dollars.

 

 

 Click Here to schedule a free audit and see if your billing company is aggressive enough to maximize your reimbursement

 

 

My first Blog Post anesthesia billing service

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