Lost revenue and Billing

[Pain Applicant1]

I'm just over 3 years into my own practice and I think I finally understand most of billing. It took me a long to get this point and I know I've lost lots of revenue moving through the process. I don't really see how practices can't lose money. Most doctors know little regarding billing and even fewer audit the billing process. Billers, whether in-house or out-sourced, can't go through every claim. It would go against human nature.

So, my questions are:
Do you think every practice loses revenue to billing issues? If so, how much do you think practices lose as a percentage?
Should this just be considered a part of doing business as a small practice and the loss would just need to be taken?

Does anyone care to contribute their thoughts on this?

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[freddydpt]

I'm curious about this as well. What are some of the best ways to learn billing issues? I hung out with our biller today but I'm not exactly comfortable with it yet.

 

[NOSfan]

I believe that the #1 area of focus for any successful practice should be proper coding and billing. You can worry about the cost of cotton balls later!

There are a number of good resources:

• Physicians Practice: http://www.physicianspractice.com/ (Registration required, but free)

• 3M coding and reimbursement solutions: http://solutions.3m.com/wps/portal/...-Z/Physician-Coding-and-Reimbursement-System/

• Dr. Ksovreli -- ([email protected]) Clinical Documentation Specialist

 

[emd123]

There are always losses. The key is to make that number as close to zero $ as possible. One thing I do is keep track of the unpaid claims and those on hold and hound my billing people. Also, I'll spot check reimbursement on past procedures and I do occasionally find stuff that wasn't paid, or got screwed up, or left Un-billed. It's maddening but a lot of docs don't follow up on this stuff and they're bleeding red ink. There are a lot of losses inherent in this awful fee-for-service system, especially with the amount of shade pulled by some insurers just not paying for certain things. I wonder daily about how much more I could be collecting or keeping. It'll eat you alive if you let it. I don't think there's a way to perfect it, just minimize losses and maximize efficiency. I wish I had a better grasp on it myself, but the system is so god awful complex it's another full time job for several people just keeping track of it. Do your best.

 

[hyperalgesia]

The claims process is like a leaky hose, designed to seep money and I'm sure that insurers and contractors have it built into their financial models. It would be interesting to talk to an insurer and see what percentage of claims they EXPECT to be lost by the submitting practice.

 

[ampaphb]

I was just informed of two additional codes I had heretofore not billed for (99403 and G0396 - counseling the patient on the safe use of opioids) and (99420 administration and interpretation of a health risk assessment instrument). I, for one, am always learning.

 

[Yo GabbaPentin]

Not to derail the topic, but what is a reasonable % of collections to pay a billing company? I'm paying 6%.

 

[NJPAIN]

I was just informed of two additional codes I had heretofore not billed for (99403 and G0396 - counseling the patient on the safe use of opioids) and (99420 administration and interpretation of a health risk assessment instrument). I, for one, am always learning.

Do you know if the counciling code is a one time thing or can you bill each time you pound it into their heads


Sent from my iPhone using SDN Mobile

 

[bedrock]

I was just informed of two additional codes I had heretofore not billed for (99403 and G0396 - counseling the patient on the safe use of opioids) and (99420 administration and interpretation of a health risk assessment instrument). I, for one, am always learning.

can you charge the counseling code together with a normal clinic visit code? Same question for the 99420

 

[Pain Applicant1]

Here's some helpful information on some codes that I've come across.

http://solodocssolong.blogspot.com/2013/03/good-cpt-codes-to-know.html

Taken from site above:

"99406 and 99407: Smoking cessation counseling. 99406 is the CPT code to use when a provider spends 3 to 10 minutes talking about the benefits of quitting smoking (or staying quit, for those who no longer smoke, but have underlying health problems related to past smoking), and 99407 is the CPT code for spending more than 10 minutes on the subject of smoking, especially when a patient has indicated a desire to quit and wants to put together a plan, with the provider's help. These codes are covered by Medicare, up to seven sessions per year (more may be covered, under special circumstances). These codes may be billed at the same time as an office visit, if the ICD-9 diagnoses aren't the same for both. There is a long list of supporting diagnosis codes, but the most reliable are 305.1 (tobacco use) and 496 (emphysema, which all long-term--greater than 5 years?--smokers have, to greater or lesser degree). Use a 25 modifier on the office visit, and a 59 modifier on the smoking counseling code. Make sure you have a documentation sheet in the chart, indicating what general areas the smoking discussion covered. Although insurance carriers may not like forms, it's absurd to expect a doctor to hand-write or e-write every word of a smoking cessation discussion in the chart."

"G0396: Alcohol and/or substance abuse assessment and counseling, up to 30 minutes. This code is covered by many insurance carriers, but not Medicaid. It's sister code, G0397 is different only in that it communicates that more than 30 minutes was spent in provider-patient assessment and counseling. Use a 25-modifier on the office visit, and 59-modifier on the G0396 code. There is no limit on the frequency of substance abuse counseling, which seems appropriate given the challenging nature of addiction. Use 303.91 (current alcohol use), 303.93 (history of past use), or any of the many other addiction ICD-9 diagnoses to support this CPT, e.g., THC, cocaine, heroin, or amphetamine use."

 

[NOSfan]

Not to derail the topic, but what is a reasonable % of collections to pay a billing company? I'm paying 6%.

6% is a competitive rate as the industry typically ranges from 6-10%

http://profitable-practice.software...d-you-outsource-your-medical-billing-1032610/

 

[bedrock]

Agree that 6% is reasonable. Can do still better.

Our practice just finished an extensive search, and will be going with a well-established regional company, charging 4.5%.

 

[ampaphb]

Can you PM me the name of the company you are using?

 

[ampaphb]

The problem with a fixed rate for all collections is it encourages the agency to only go after the low hanging fruit. They have no incentive to work on the tougher claims. In the past, I have found it better practice to propose a tiered system, where they get X% for claims of 0-60 days, X+Y% between 60-90 days, and X+Y+Z% >120 days.

 

[pastafan]

The problem with a fixed rate for all collections is it encourages the agency to only go after the low hanging fruit. They have no incentive to work on the tougher claims. In the past, I have found it better practice to propose a tiered system, where they get X% for claims of 0-60 days, X+Y% between 60-90 days, and X+Y+Z% >120 days.

Interesting. What is the spread between X and Z?

 

[hyperalgesia]

The single biggest loss I have is when I'm not on the network: I bill the insurance and they may or may not pay the patient. Then I'm supposed to call the insurance to see if and how much the pt owes me and then bill them that. It's such a PITA.

 

[jonnylingo]

There is no limit on the frequency of substance abuse counseling, which seems appropriate given the challenging nature of addiction. Use 303.91 (current alcohol use), 303.93 (history of past use), or any of the many other addiction ICD-9 diagnoses to support this CPT, e.g., THC, cocaine, heroin, or amphetamine use.

I hope what you've stated is correct. I've heard from our billers that the counseling can be used only once. Then done. no more reimbursement. Even if another doc in another department counsels. I therefore feel sheepish using this code...my rationale is that PCP should be using this since they are usually the ones Rx'ing the patch or gum and following up.

 

[Pain Applicant1]

I hope what you've stated is correct. I've heard from our billers that the counseling can be used only once. Then done. no more reimbursement. Even if another doc in another department counsels. I therefore feel sheepish using this code...my rationale is that PCP should be using this since they are usually the ones Rx'ing the patch or gum and following up.

I say nothing. Copied from link provided in post.

http://solodocssolong.blogspot.com/2013/03/good-cpt-codes-to-know.html

 

[jonnylingo]

Thanks for the link. Interesting and helpful. What do you all think about getting very detailed with these codes and trying to use them to reflect your work, VS. just billing for time?

 

[hyperalgesia]

If you have a small, part-time, low volume practice with minimal support and minimal overhead and you spend a lot of time with pts, billing by time makes life easy. You can keep your exam focused and don't have to document BS that is not pertinent. You can instead spend that time educating the pt and being a real doctor.
If you have a medium to high volume practice and have staff members to help out with documentation, you can't bill by time and you don't want to. You put pts on the conveyor belt like Medicare wants you to and check off the boxes.

 

[sblau001]

I was just informed of two additional codes I had heretofore not billed for (99403 and G0396 - counseling the patient on the safe use of opioids) and (99420 administration and interpretation of a health risk assessment instrument). I, for one, am always learning.

Can you use G0396 for interpretation of certain screening tools like SOAPP-R?