From Dr Joanne in Drain, Oregon,

From Dr Joanne in Drain, Oregon,
>
>       The reason you haven't heard much from me recently is that I
am now starting to do my own billing. I had a billing expert who
came in 10 hours a week to bill for me, but I was seeing more
patients, documenting the way she told me to, and not getting more
money. So I decided to bite the bullet and learn Lytec well enough
to bill for myself and find out why.
>        As of two weeks ago, I have been billing the day's patients
the end of every day, and am starting to cream through my old EOBs
and do all the challanges, rebills, charging to secondary billing,
etc,etc that one must do to actually collect what you are allowed to
get from these folks. It is irritating and time consuming, but it
certainly is making me a better coder as well as collecting a
reasonable amount of money.
>       What was happening with my (everyone says including the MD
she is working full time for) skilled billing person, is that she
was skipping the tough ones: For example, Blue Cross Blue Shield 65
Plus is supposed to have a primary care provider that they have to
access first. Some of them can come here for very acute problems if
they can't get into their primary provider. They may be rejected
for payment: however;   if so, one can rebill straight to Medicare
and get them (mostly) covered, except for 15 or 16 dollars. I found
25 or 30 of those that never got rebilled to Medicare.
>       No, I didn't fire the part time worker. I have a rule
that "you can never hire anyone to do anything you don't all ready
know how to do yourself, better." I think it was my fault for not
learning the system myself first. And the worker is doing a much
better job now, too.
>       I think the business was just getting too busy for one part
timer, and I am not willing to hire someone full time for this; I
refuse to become anything but a low overhead practice.
>
>      Thinking about a second way increase income. I have been here
in Drain long enough that I seem reliable to the local businesses
for on-the-job injuries. Workman's comp pays like a trooper, if you
keep good documentation. I am starting to become the one they send
these folks to, and I have started to visit the local
factories/businesses to offer my services. Businesses tend to have
habits of behavior for injuries, and if you are their first choice,
you can get some good cases, with great followup coverage. Here,
these businesses are mills and machinist shops, with some logging
companies, which have rather specific types of injury.
>
>                                Joanne

From: "Annie Skaggs" <askaggs@fayettefamilymed.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Sun, 23 Apr 2006 08:28:42 -0400
Subject: RE: [Practiceimprovement1] various issues: learning billing, EOB grooming, and income
Reply-To: Practiceimprovement1@yahoogroups.com

HI Joanne in Drain,

Congrats on your expanding skills. It really is eye-opening to dig into “working the claims”

One thing that stood out to me, however, was your statement that WC “pays like a trooper”. I hope that continues to be true for you, but for me, WC is a nightmare. About half the time they never pay at all, and take a year or more to ever actually deny, so by then it’s too late to try the regular health insurance. When they do pay, (after 90 days usually), they pay thru subcontracts to really rotten payers like FirstHealth or BeechStreet, and pay about 60% of what I would get from most private insurances. Two or three times over the past 4 years I have gotten 100% of charges, and I guess that is what has kept me trying, but not anymore. I have just put in place a policy requiring pay up front from the patients if they want me to see them for WC or auto insurance related problems. Auto insurance also has occasionally paid 100%, but much more often, by the time they go to the ER, that uses up all the available benefit, so when I see them for the f/u, I get nothing.

On a cheerier note, I learned from the practicmgt listserv some tricks like billing preventive plus OV on the same DOS with -25 on the OV for chronic disease mgt, and that has almost doubled my reimbursement for visits where I was giving “one-stop-shopping” and providing complete preventive service PLUS all their chronic med refills and disease follow up testing, etc. The only thing I don’t like about it is that I have to write two completely different notes for the one visit, but good thing I do because a couple times they requested the records before they would pay. I also am getting some payments for 99050, 99058 and now 99051. Next I am going to try the prolonged service codes.

Good luck with your business adventures!

Annie