I’m sure you’ve all seen AT&T’s iPhone commercial:
“Want to check snow conditions on the mountain…There’s an app for that.“
“Want to check how many calories are in your lunch…There’s an app for that.“
Well doctors, I want you to think of this every time you provide a service for a patient: There’s a CODE for that!
Ever consult with a patient over the phone? There’s a code for that.
Give a patient a handout for home exercises? There’s a code for that.
And somewhere out in the abyss there’s an insurance company that will actually PAY for that code.
I’ve been in many different medical offices here in Sacramento, both as an employee and as a patient, and I’m always surprised by how many services go uncoded and unbilled. What’s almost worse is when a doctor provides a service, codes it, but has absolutely no idea if the code ever gets paid, how much they charge for it, or what the reimbursement is if it actually does get paid. Ignorance is definitely not bliss in this situation – it’s expensive.
Fortunately, with a little time and a little research, this can be easily remedied.
STEP 1: Go around your office and make a list of every piece of medical equipment you would use on a patient and any item you would give to a patient – from massagers to handouts to vitamins – anything you can think of, including the services you’re already coding and billing.
STEP 2: If you don’t know the code, pull out your old dusty code book (I know you don’t buy new ones every year even though you should) and look it up. Since the AMA owns all the CPT codes, good luck trying to find out what a code is online. Sometimes if I Google a particular service I can find out what the code is but it’s not always accurate and can take some time. So if you don’t have a CPT code book, BUY ONE. Note that when you’re looking up codes, pay careful attention to things like time units if they apply – like with certain manual procedures or E&M’s – the last thing you want to do is bill for a code that turns out to be fraudulent.
STEP 3: Once you’ve got all your codes together, the next thing is to figure out what the reimbursement is on them. If you’re contracting with any insurance companies this part is fairly easy – you can either call the insurance companies you’re contracting with and they will tell you what the reimbursement is, or you can go to their website and access a fee schedule (Blue Shield has a great one on their website). Finding out reimbursement from insurances you don’t contract with however can be a little trickier. The best way I’ve found to do this is by calling the insurance company and verifying that a particular code is on their fee schedule, then trying to get them to tell you what the allowable amount is. Usually they won’t tell you the allowable amount, so the next step is just to provide that particular service to a patient and bill it. Once that EOB comes back you’ll have the answer you’re looking for.
So now that you have all of this information, what should you do with it? IMPLEMENT IT! Make two excel spreadsheets – one for contracting insurances and one for non-contracting insurances. In these spreadsheets you’re going to list all the CPT codes you use and the reimbursement rates for those codes, based on the insurance company. It should look something like this:
Some of this information will take a few hours to get, and some will take days or weeks or months – just stick with it diligently. My advice is to keep an insurance ‘bible’ that has this information in it and update it as you go along. If you have a medical biller in your office, they can be filling in all this information when EOB’s come in. When it’s all done print it out and laminate it – keep a copy at the front desk as a reference so both you and your staff will always know what insurance company covers what code and how much you can expect to be paid for it. Before you know it, your entire office will be more focused on making sure all the services you provide get CODED AND PAID!
I feel that this is a valuable and mandatory tool for every medical office to have, so I routinely provide this service to all of my clients when they sign up with me for medical billing services. If you already contract out your medical billing, make sure to ask them if this is something they can do for you.
Doctors: All you’ll have to do now is make sure to fill out all your routing slips : ) Have fun!
For more information about how Sacramento Medical Billing can help improve collect more, please contact us at (916) 583-8605.