It is no surprise in this day and age to read about hospital bills gone awry. Millions upon millions of dollars mistakenly included on a medical bill. That is what Part I will address, human error.
Mistakes happen, that is part of life. And sometimes when we try the hardest we make the most. The same applies to entering orders. A wrong test is ordered, or wrong date or not in proper time sequence. It could happen and it does happen.
From personal experience I can tell you I have been called by lab, radiology, pharmacy and even dietary questioning about an order in the computer. Fortunately not all in the same day on the same patient. Just recently lab called about an order, a magnesium was scheduled to be drawn even though one had been done earlier in the morning. Since there was no order, I canceled the new one.
I have been in situations where a lab or x-ray was needed immediately. In those cases the department will render the service and will ask you to put in the order later. Even a reminder if it is forgotten. Patient safety is not at risk just because an order is not in the computer.
Once the situation has passed is an order placed? That is the goal yes, but like other things sometimes it is missed.
Other safe guards are in place also, for instance hospitals may require doctors to enter their own orders into the computer. This eliminates several steps and presumably would cut down errors. Nurses routinely do chart checks to make sure the orders are noted and correct.
And remember those stickers and supplies? I can give you a personal example, this happened a few nights ago. I had two sick patients and I was very busy running from room to room giving care. At the end of the shift I had sticker all over my uniform top from the supplies I had used.
When it was time to affix the stickers to the "charge cards" I had to remember which sticker and corresponding supply I used for which patient. I am sure I did just that, but with the acuity of patients nowadays and the hectic work load stickers can be misplaced.
Even well intentioned actions intended for comfort of the patients can lead to unforeseen consequences. As I have said I have worked in a variety of care setting. This example took place in the Neonatal ICU. There we routinely put small fleece squares in the bottom of the isolette to prevent skin breakdown.
Little did we know that these fleece squares also at times made the x-rays appear patchy, with more white than there otherwise would have been. So what started as a well meaning comfort measure actually was counter productive. The reason for the patchy x-ray was quickly discovered by a bright physician and fixed.
Billing errors are common on hospital and medical bills. And as I have described above some of these overcharges are the result human error inputing the charges. Part II however deals with a different sort of problem.
Medical billing services have a number of basic steps they should incorporate into their billing process. These steps should include using a claims scrubber, use of no-response calls, posting zero pays, pursuing underpayments, and using likelihood of payment scores for patient collections.
Pursuing underpayments is the focus of today's article. This pursuit begins first and foremost with comparing the payment information from EOBs to the allowables outlined in the practice's payer contracts. This comparison must be done in an automated manner and cannot rely upon payment posters catching the underpayments on their own.
The need for automated comparison to allowables is not because of any short coming with the average payment poster, but because payers employ sophisticated techniques to make underpayments difficult to identify. Medical billing companies with well designed processes can counteract these techniques because they have much more scope than a single medical practice. By scope I mean that they see what payers do across multiple providers in multiple states. This broader view of the world allows a billing company that is leveraging its scope to uncover payer behaviors more easily than a single medical practice.
A disturbing pattern that can regularly be seen by a medical billing company that is paying attention is one where a payer will select a set of procedures and underpay this set of procedures across a large number of providers (often by the same amount). This will continue for about 30 days and then the payer will resume paying the procedures at the correct amount and begin underpaying a whole new selection of procedures.
Each individual underpayment is typically less than $20 and often less than $10. It is, however, death by a thousand cuts as these small losses can quickly reduce a medical practice's revenue by 5 to 10 percent. The tactics of constantly switching which CPTs are being underpaid and then underpaying in amounts that are small at the claim level make it hard for a practice to realize the magnitude of the money they are losing.
The pattern outlined above is why it is critical that a strategy for pursuing underpayments is not based upon payment posters picking up on the underpayments. Most payment posters will notice a large underpayment, but it is too much to expect them to spot a $5 underpayment.
This single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed by your medical billing service.
Spotting the underpayment is only part of the battle, of course, the billing service also needs to have a systemic process in place for pursuing the underpayments. It is critical to pursue event the small underpayment amounts. Once a payer sees that their resources are being tied up readjudicating claims because of a $5.00 underpayment, the underpayments will often cease to happen.
Both Doris Goodbody & Carl Mays Ii are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Doris Goodbody has sinced written about articles on various topics from Health, Finances. We are in the business of finding errors and overcharges on hospital and medical bills. Let audit your bill. You have nothin. Doris Goodbody's top article generates over 12100 views. to your Favourites.
Carl Mays Ii has sinced written about articles on various topics from Cardio Training, Health and Finances. Carl Mays II, CEO of ClaimCare , has spent the past 15 years enhancing the financial performance of his clients. To read more about selecting. Carl Mays Ii's top article generates over 12100 views. to your Favourites.