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A Better Level of Service
Billing
for services is much more than printing up a claim and sending it out.
Billing is about reimbursement, getting the money to the office and getting
it there as quickly as possible.
Billing
is about the patient. We "take care" of the insurance billing for
our patients as a courtesy to them. As alternative
practitioners we establish a relationship with our patients. Both
acupuncture and chiropractic services require multiple visits for effective
results and healing. We get to
know our patients, unlike other medical specialties. We want patients that refer, we want
patients for life. That requires providing a better level of service.
Our
Service Begins with ACCURATE Verification of Benefits
A lot
of billing services don’t offer verification, and it’s obvious
why, IT TAKES TIME! Plus not all verifications will
result in an insurance patient. Some billing services don’t
want to take the time verifying coverage for a patient that can’t be billed.
We feel differently. We want to do it, and we want it done
right. This is a service we provide out clients and it must be done
correctly whether we end up billing the insurance carrier or not.
Accurately
verifying coverage requires spending lots of time on the telephone. While
some Insurance carriers offer fax back verification or online benefit
checks we’ve found it is usually not specific enough to accurately
verify acupuncture and chiropractic benefits. We’ll use it for
certain carriers, but for the most part we make a call, or two, or three.
It is not unusual for us to confirm coverage with a number of different
representatives, and it's all done for specific reasons. We’ve had benefits quoted, not
once but three times Only to find the representatives "made a mistake”.
Because we were quoted benefits (and they were recording and noted by the
carrier) we were able to be successful in appeals to get the benefits
quoted for our patient, not what it turned out to be his actual coverage.
Secondly you need to know whether you are dealing with an actual
insurance carrier, or if the carrier is acting as an administrator
for a self insured plan. Each
type falls under different categories governed by different laws.
It
Continues With Getting the Claim Out as Quickly as Possible.
Every
billing service utilizing electronic filing, EVERY service. What they
don’t tell you is not every claim can be sent electronically. All work comp claims go paper, a lot
of smaller self-insured plans will not accept electronic submissions. Some
carriers will only accept electronic claims for in-network providers.
During
normal business hours we send out all claims with 24 hours of receiving
them, both the electronic AND the paper claims.
In cases
of patients with multiple insurances, (primary and secondary) we send all
acupuncture claims that have Medicare as primary to both carriers at the
same time. A lot of secondary carriers realize that Medicare does not cover
acupuncture so we can turn a denial around with a phone call, and if we
can’t we know that a denial is being created that we can request and
submit knowing our claim is
already in the secondary carrier’s system.
We
also stay up with code changes. In the last 20 years we’ve seen
chiropractic codes change twice. When acupuncture codes changed in 2005 we
were ready. Experience taught
us that not all carriers would be accepting the new codes during the first
of the year. We instructed our clients to sit tight we would continue to
utilize the old codes until we sure that each carrier was up and running
with the new codes. That made a big difference. Sure, we received more
denials than we usually do, but we saw many fewer claims than
services/offices that made the switch to all carriers. Over and over
we heard stories of denials of the new codes, old news to us. As each carrier
made the switch, we did too.. Was it more work for us? Yes, A LOT. But
experience told doing it this way would keep reimbursement flow to our
offices.
Experience
also helps us in the work comp arena. For example, in the State of California Federal
worker’s compensation uses different codes than State Worker’s
compensation which uses different codes that regular insurance. We’ve
cleaned up claims where an office got authorization to treat a W/C patient,
but then billed using codes that weren’t authorized or codes that
aren’t recognized. It’s the reason we like to be part of the
authorization process. Just like with insurance verification, we have the
experience to help get the authorization that will match with the bills we submit.
Double
checking Explanations of Benefits Completes the Process
Benefits
have been double checked, accurate claims have been submitted. A good
percentage of claims are still going to comeback incorrectly paid, and
guess what? It’s almost always in the favor of the insurance carrier.
We don’t just resubmit the same claim again, expecting a different
result. We make another call to the Insurance company. We always follow up
with a paper trail, sent both via fax and mail. Over the years we’ve
collected the fax numbers of a majority of the insurance carriers,
(something they don’t just give out) but we don’t rely on that
alone. So it’s a phone call, a fax (when possible) and a written
request for reprocessing.
Finally
Working Your Aging
This
is another area where experience is beneficial. We’ve sent your
claims electronically, we know this insurance carrier usually pays in 14
days, two weeks go by, we make a call. Electronic claims submission is not
infallible. Clearinghouses will tell you, they’re not sure why but
sometimes they don’t receive electronic submissions that show as
having been received. Mail is even less reliable. True insurance carriers
are subject to interest penalties, for slow pay, they generally pay quicker
and that is why they all accept electronic submissions. Self-insured are
also required to pay on a timely basis but there are no penalties they are
required to pay. We take all these things into consideration when
submitting a bill and awaiting payment
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