Redundant systems help prevent charges from falling through the proverbial cracks. Billers scour doctors’ progress notes for references to any tests or procedures they’ve ordered. Then they thumb through the charges to make sure those tests or procedures are recorded. If they aren’t, they contact the doctor. “They understand that the billing department has the authority to call them any time of the day about missing charges,” Avery says.

Accountability works in the other direction, too. One doctor, says Avery, will occasionally hold back a charge ticket on a hospitalized patient to see if billers will catch the omission. “She wants to know that you’re watching her money.”

At Mid-South Pulmonary, physicians typically submit inpatient charges on the day of service using a printout of an individual rounding list with fields for diagnostic and CPT codes. Many of them fax or e-mail the form to the office from their home after they’ve hung up their stethoscope. Avery says her doctors started becoming sticklers for promptness 11 years ago after they learned that $400,000 in charges had to be written off due to untimely filing. “They had no idea,” says Avery. “They thought they were doing everything right.”

The moral of the story? Teach physicians that discipline and sloppiness each has its financial consequences. They’ll figure out the right path to take.

Have coder, use wisely

Having expert coders on staff is Billing 101. Using them intelligently is Billing 201, says practice management consultant Judy Bee.

“I see too much data entry by coders,” says Bee. “Just copying information from the charge ticket into the computer is a bloody waste of their time. True, they fix problems like missing modifiers and diagnostic codes in the process, but it interrupts data-entry, and that’s a lower-level job anyway.” Instead, “coders should review and correct all charge tickets and then hand them off to data-entry clerks.”

Bee says that highly trained coders make too much money to be used for tasks that a clerk could complete. They’re better-used for “analyzing denials … writing appeal letters to insurers, reviewing insurance contracts,” and other higher-level functions that, when done well, can generate the practice big revenue boosts. For example, Bee recalls a contract that included an absurd restriction — “a limit of two diagnostic codes per claim, as if patients only had two problems.” Such an arbitrary clause could cost a practice thousands of dollars over the course of a year, yet coders might overlook this problem if their time is swallowed up by endless modifier checks and tedious data-entry.

“Coders also should be reviewing charge tickets each year to make sure that listed codes are up to date and the most frequently billed by the practice,” Bee adds. “I like to put those people to work with their brains, not just with their fingers.”

Fix your edits quickly

Everybody knows insurance claims shouldn’t go out the door unless they’ve been edited for possible errors — either by human eyes, or better yet, by tireless scrubbing software. These programs may come standalone or as part of your practice management system. You naturally want your system to suspend dirty claims instead of submitting them as easy candidates for rejection or denial. It’s often a matter of missing information — a modifier, a diagnostic code that would support a CPT code, or the name of a referring physician.

But all too often, practices have no follow-up routine for fixing and submitting suspended claims in a timely manner, so these charges just loll about in the system, says Mertz. The longer they loll, the longer you wait for your money, unless claims stagnate so long that you miss a filing deadline. Avoiding the problem of unresolved edits is another example of advanced billing know-how. “When the machine says, ‘We can’t send this out,’ somebody has to fix this problem,” says Mertz.

With many practice management systems, edits appear in real time as a biller enters charges, allowing her to fix them immediately if the solution is handy. If the edits are unresolved, a good system will let you assign them to the right staffer to remedy. For example, if your edits have caught a missing insurance number, you can put the claim in a work queue for a front-desk staffer. Create a protocol for who fixes what, and by when, says Keegan.

“Edits should be worked as soon as they pop up,” she says. “Unless the problem is out of a practice’s control, they should be wrapped up at least within five days.” To keep everybody on their toes, Keegan advises generating a report tracking the lag time between when a dirty claim is suspended and when it finally goes to the insurer all spiffed up.

Advice for Specialists Specialists worried about revenue as well as Medicare audits should examine a key metric: the volume of their office consults compared to new-patient office visits, says practice management consultant Sarah Wiskerchen with Karen Zupko & Associates. Why? Because consults pay 21 percent to 30 percent more; you want to bill for them whenever it’s appropriate. But be careful about overdoing it: You don’t want to trigger an audit. Average consult-to-new-patient ratios vary by specialty, according to Medicare claims data. Neurosurgeons, for example, typically bill six times as many consults as they do new-patient visits. A neurosurgeon who’s billing only three times as many consults to new-patient visits is likely coding gobs of bona fide consults as new visits, and leaving money on the table, says Wiskerchen. But if her ratio is 12 to one, a Medicare auditor will wonder what’s up. “You’re going to stand out,” says Wiskerchen.

Conventionally unwise

There’s plenty of conventional wisdom about following up on unpaid, denied, or underpaid insurance claims. A word to the wise: Conventional wisdom needs some fine-tuning.