One of my favorite books, from all of my studies, is From Good to Great by Jim Collins. He refers to the “hedgehog concept” within the three circles of success. You must:
1) be the best in the world at what you do,
2) keep your passion high,
3) have a profit center in each part of your business
Health and wellness care are businesses and we must learn to treat them as such. I can teach you the first two because we are the best in the world at what we do in “Solving the Health Puzzle” by identifying the six interferences to health and correcting them through the “Six Steps to Wellness.” Getting incredible results and helping those people that had given up hope keeps your passion for the work and life at an all time high. I have asked Brandy Beeson, who works as a consultant with Capacity Management, to do a series of Puzzle Pieces on “how to increase your bottom line” for the third part of Collins’ findings.
Do not miss one word of this article, and the articles to follow. Coming soon is the article on which codes can be successfully billed to most insurance companies for laser. Many have used codes that their records did not substantiate properly, like neuromuscular re-education, and they have had to refund thousands of dollars back to insurance companies, plus attorney fees. Read the Puzzle Pieces please – the price is right…
~Insurance Follow-up, Appeals and Resubmissions~
By: Brandy Beeson, Capacity Management
It is vital for any practice to closely monitor all areas of your practice and have solid systems in place, including the billing and collections department. The Accounts Receivable Program offered by Capacity Management will help you to refine your office systems to insure that it is functioning optimally. The following information offers a glimpse of what this program offers:
Often times, a resubmission to an insurance company is necessary in order for claim to be processed, so your record keeping follow-up systems should be very organized. If second claim submissions are not sent electronically, they should be sent with an Insurance Tracer, which most software systems are able to prepare and print. This form immediately lets the insurance company know that they should have previously received the claim. You must also keep record of the original submission date. In the event of a denial, for timely-filing purposes, it is up to the provider to prove that the claim was submitted within the timely filing statute. If your software does not have the Insurance Tracer capability, make sure that your clearinghouse does.
Following these simple steps should help to organize and maintain an efficient insurance Accounts Receivable system:
1) Original insurance billing is best if done weekly or bi-monthly to maintain consistency.
2) Open invoice (unpaid claims) should be reviewed a minimum of once per month. It is most efficient if they are reviewed after payments have been posted for the business day/week.
3) Second submissions (with tracers) should be submitted thirty days after original submission date for electronic claims. Forty-five days is acceptable for resubmitting paper claims (with tracers.)
4) Thirty to forty-five days after second submission has been sent, if EOB/ EOR or any other form of insurance remittance (ex. Request for more information) still has not been received, open/unpaid claims should be called on immediately.
5) When performing follow-up calls on open claims, be sure to keep an accurate call record. Most software programs have this capability. If not, an insurance call log should be kept in the patient file or in a separate ‘follow-up’ file until the claim is processed and closed. Details of this call log should include: The day and time of call, the claims representative name and, of course, the current claim status.
Many insurance companies allow for claims status to be checked online. It can be very useful and time efficient to register with these companies and view your claims regularly. This, too, will help you with your follow-up and resubmission processes.
There are multiple reasons that an insurance appeal may be needed to obtain complete payment or correct processing of a claim. For example, an appeal may be required if the entire claim has been processed but a code possibly paid at a reduced fee (which is less than the contracted amount) or the insurance processor may have completely missed the processing of a billed code. In the event that an insurance appeal is necessary, this may be done in two ways, depending on the situation of appeal.
Appeal requests may be sent via fax/mail or handled over the telephone with a claims representative. The best, and most efficient, way is to handle this over the phone, if possible. A call log or call notes should be kept any time contact is made with an insurance company. Depending upon your particular office systems, an “appeal file” should be maintained and information on every appeal entered into current practice software.
For additional information or help regarding these processes, please contact Brandy at Capacity Management at (303) 242-8901 or via e-mail at firstname.lastname@example.org.
There you have this installment of increasing your bottom line. Brandy is an incredible resource and can be enlisted at a fee per hour, or you can have her come in-office for one or two days to review each aspect of your office and procedures. She will teach you and your staff how to become more efficient and profitable. It is the bargain of a lifetime. Almost everyone that has done the in-office consultation wants her to come and run their practice, but that is not an option. She comes to many Nutri-West seminars and will teach parts of the staff training and answer questions there. She knows back and front office procedures and can help you profitably add the Nutri-West nutrition and other wellness aspects to your practice.
I will return this week from spending two weeks with Dr. Moon in Korea. I will be covering some of the new genetic-genomic understanding I’ve received, at each seminar. We, at Brimhall Seminars and Products, look forward to seeing you at a Nutri-West/Brimhall Seminar very soon.
Wishing you health, wealth and happiness,
John W Brimhall, DC and the Wellness Team