OMA Newsletter

Best Practice Newsletter - Fall 2012

Ask the Practice Management Experts

Rosa D’Ascoli, CPC, CPMA, Practice Manager, Vascular Associates of New Jersey in Livingston Rosa D’Ascoli has served as practice manager for Vascular Surgeons Bruce Brener, M.D., and Cindy Sturt, M.D., with Vascular Associates of New Jersey and Barnabas Health for five years. She has extensive experience in billing and coding, having worked in the field for more than 20 years. Rosa holds certifications as a professional coder and professional medical auditor through AAPC. She also earned a bachelor’s degree in psychology from Montclair State University and a paralegal certificate from Fairleigh Dickinson University.

“Ask the Experts” is a question-and-answer forum featuring leading practice management experts.

Q: As practice manager, you oversee medical billing, accounts receivable, and the implementation of office policy, which all contribute to reimbursement. Why is this so important to medical offices?

A: Running a medical practice is very complex and expensive. Each employee in a medical office has a unique role in making an office run in the most efficient manner. Every employee, from the front desk staff to the physicians, plays a very important role and function.

Q: What are some of the problems you encounter frequently when seeking reimbursement?

A: There are a number of problems that we run into when seeking reimbursement from insurance companies, ranging from the insurance companies not processing claims in the contracted time frame, to denying claims because codes bundled together did or did not have appropriate modifiers attached, to sometimes even stating they did not receive the claims. I’ve also found that physicians’ offices don’t always appeal denials as they can be time consuming. Although that’s true, the insurance companies aren’t always correct in how they process or deny a claim.

The problems aren’t just limited to insurance companies. When patients don’t pay their co-pay at time of service, it causes more overhead for the office. I have been told that every statement sent from a physician’s office can cost up to $10 between the supplies, postage and the employee’s time to stuff, address and mail the envelope.

Q: Have you found many successful ways to rectify these problems? Do you have any tips to share?

A: Yes, I’ve actually found a number of ways to deal with these issues.

In my experience, having a certified coder responsible for billing and accounts receivable is extremely useful, as they know how and when to use modifiers and NCCI edits and when to dispute denials from insurance companies. If a certified coder is not on staff, the biller should know how to bill that specialty correctly and most efficiently. I’ve also found that in order to be most successful, billers should be dedicated solely to billing, accounts receivable and payment posting. Billing is one of the most important jobs and shouldn’t be left to an employee with a number of other tasks on their plate.

As I mentioned, sometimes payment is not received in the time promised by the insurance company. When this happens, I’ve found that re-billing the request and indicating “second request” on the claim, whether electronically or in print, helps with the process. Additionally, practice management software that can run insurance eligibility checks is a great investment. If run each day with the upcoming patients, the office can see if any scheduled patients are no longer eligible with the insurance company and correct the issue with the patient prior to the visit.

I’ve also found that it’s very important to develop a policy regarding patient co-pays and treatment and post it publicly for the patient to see. This informs patients of their options should they not have their co-pay and leaves little room for excuse. Some offices will not see the patient without a co-pay. My office, for example, has protocol that is posted in numerous places throughout the office and exam rooms and states that if the co-pay is not paid at time of service, an additional $10 fee will be charged to the patient’s account. We also inform patients of each type of payment we accept as well as the location of a nearby ATM machine.

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