Below are some practice guidelines for your consideration. Most of these are in regards to your receivables but there are a few operational guidelines as well. For phlebology practices, the number of claims that 'age' due to notes requests and denials will always be higher than the non-specialty standards noted below.
1. Visits without charges as a percentage of total visits.
0%
2. Copay collections as percentage of total copay office visits.
Greater than or
equal to 95%
3. EDI claims as a percentage of total claims billed.
Greater than or
equal to 90%
4. Charge entry lag period.
Equal to or less
than one business day
5. Claims passing claims edits as a percentage of total claims.
Greater than or
equal to 98%
6. Appointment no show rate.
Less than or
equal to 3%
7. Appointment bumped rate.
Less than or
equal to 3%
8. Net A/R days (non-specialty).
Less than or
equal to 40 days
9. Collections as a percentage of net revenue.
Equal to or
greater than 100%
10. Collections as a percentage of gross revenue (non-specialty).
Equal to or
greater than 60%
11. Third party A/R aging greater than 90 days from last activity date.
Less than or
equal to 10%
12. Denials as a percentage of net revenue (including “incidental to” services).
Less than or
equal to 2%
13. Claims with no activity greater than 90 days from last activity date.
0%
14. Credit balances.
Less than or
equal to 2 A/R days
15. Average patient wait time after office arrival.
Less than or
equal to 15 minutes
Published in HFM, July 2007, Magazine for the Healthcare Financial Management Association. Written by David C. Hammer. Posted by kind permission by Mr. Hammer.
Friday, January 30, 2009
January/February Marketing Tip
MARKETING TIP:
It is cold and flu season for the PCP’s so they are pretty busy this time of year. However, now is a good time to reach out to other types of providers.
OB/Gyn practices can be a good source of referrals. Try to stop by and visit with the practice manager and the referral coordinator. Better yet, try to have a lunch-and-learn between physicians about varicose veins and how the cosmetic varicose veins can be an indicator of underlying reflux. One thing to be careful about here is cosmetic services. More and more OB/Gyn practices are adding cosmetic services. You do not want to talk about competing services or you will never get a referral for some of the other services you provide.
Podiatry can be another good source of referrals. Patients often go to see a podiatrist for ankle pain or even ulcers. Their pain ends up being reflux. It is easy enough to establish a bit of reciprocity by allowing the podiatrist to place some of their cards or flyers in your office in exchange for referrals and placing cards/flyers in their office. I also recommend inviting the podiatrist to watch an EVLT or two. They typically will not actually come but… as podiatrists are not MD’s/DO’s, they are also not always treated well by the hospital, surgery centers, and physicians. Inviting them to your office to watch a procedure or two generates a lot of good will.
Finally, I have heard of some good success working with wound care centers. If you have one anywhere near you, I would recommend establishing a meeting with their facility administrator and their medical director. Let them know you really do not want to treat the ulcers per se; but that you can likely treat the underlying issues that are causing the ulcer(s). I’ve seen some pretty dramatic results of ulcers being treated not only for the ulcer but for the reflux causing the ulceration. Share some of those stories or pictures with them.
It is cold and flu season for the PCP’s so they are pretty busy this time of year. However, now is a good time to reach out to other types of providers.
OB/Gyn practices can be a good source of referrals. Try to stop by and visit with the practice manager and the referral coordinator. Better yet, try to have a lunch-and-learn between physicians about varicose veins and how the cosmetic varicose veins can be an indicator of underlying reflux. One thing to be careful about here is cosmetic services. More and more OB/Gyn practices are adding cosmetic services. You do not want to talk about competing services or you will never get a referral for some of the other services you provide.
Podiatry can be another good source of referrals. Patients often go to see a podiatrist for ankle pain or even ulcers. Their pain ends up being reflux. It is easy enough to establish a bit of reciprocity by allowing the podiatrist to place some of their cards or flyers in your office in exchange for referrals and placing cards/flyers in their office. I also recommend inviting the podiatrist to watch an EVLT or two. They typically will not actually come but… as podiatrists are not MD’s/DO’s, they are also not always treated well by the hospital, surgery centers, and physicians. Inviting them to your office to watch a procedure or two generates a lot of good will.
Finally, I have heard of some good success working with wound care centers. If you have one anywhere near you, I would recommend establishing a meeting with their facility administrator and their medical director. Let them know you really do not want to treat the ulcers per se; but that you can likely treat the underlying issues that are causing the ulcer(s). I’ve seen some pretty dramatic results of ulcers being treated not only for the ulcer but for the reflux causing the ulceration. Share some of those stories or pictures with them.
Thursday, January 29, 2009
Authorization/Benefits Process
1. Call the insurance company, (the number is usually on the back of the insurance card) and ask for benefits.
- Obtain the in network benefits
- Obtain the out of network benefits as well if you are out of network with that plan
- Verify that the procedures performed are a covered benefit (typically 36478 and 36471)
- Ask to speak with the Authorization department and ask if this procedure(s) requires a pre-authorization, pre-certification, or a pre-determination
(do not believe the information from the benefits department that no authorization is required; this information is given incorrectly on a frequent basis)
- Verify the information given to you with more than one representative if they state no authorization is required. This may take multiple phone calls.
- Obtain the authorization. You should have the diagnosis code, the procedures requested, and all of the patient information at your disposal to complete this call.
- Requests for the diagnostic ultrasound and any clinical records along with a letter of medical necessity to be sent to the insurance for their review is not uncommon. It is highly recommended that a letter of medical necessity be written for all patient’s.
2. Document all conversations with the insurance company representative in either the chart or a financial chart including:
- Representative’s name
- Time and date of call(s)
- What information was given to you
- Verification of all codes that pertain the pending services
- Reference number for the call
- Authorization number
Things to watch out for:
UHC - do not believe that no authorization is required; ask for the authorization department as noted above, and verify all information. Services MUST have notification on file.
Cigna - The authorization department and claims department have conflicting information. It is very important to double check all information. It is also very important to make sure it is a covered benefit for that member’s plan.
BC/BS - Same as both of the above. Try to get all information in writing. Most Blues payers have a policy as of 01/01/08 that all EVLT procedures require an authorization.
3. Make sure your patient meets, and that you have documented, all conservative therapy requirements for that payer. It is good to keep a small reference file on what the conservative therapy requirements are for each major payer in your area. You can also ask the authorization department for this information when you check on an authorization number.
- Obtain the in network benefits
- Obtain the out of network benefits as well if you are out of network with that plan
- Verify that the procedures performed are a covered benefit (typically 36478 and 36471)
- Ask to speak with the Authorization department and ask if this procedure(s) requires a pre-authorization, pre-certification, or a pre-determination
(do not believe the information from the benefits department that no authorization is required; this information is given incorrectly on a frequent basis)
- Verify the information given to you with more than one representative if they state no authorization is required. This may take multiple phone calls.
- Obtain the authorization. You should have the diagnosis code, the procedures requested, and all of the patient information at your disposal to complete this call.
- Requests for the diagnostic ultrasound and any clinical records along with a letter of medical necessity to be sent to the insurance for their review is not uncommon. It is highly recommended that a letter of medical necessity be written for all patient’s.
2. Document all conversations with the insurance company representative in either the chart or a financial chart including:
- Representative’s name
- Time and date of call(s)
- What information was given to you
- Verification of all codes that pertain the pending services
- Reference number for the call
- Authorization number
Things to watch out for:
UHC - do not believe that no authorization is required; ask for the authorization department as noted above, and verify all information. Services MUST have notification on file.
Cigna - The authorization department and claims department have conflicting information. It is very important to double check all information. It is also very important to make sure it is a covered benefit for that member’s plan.
BC/BS - Same as both of the above. Try to get all information in writing. Most Blues payers have a policy as of 01/01/08 that all EVLT procedures require an authorization.
3. Make sure your patient meets, and that you have documented, all conservative therapy requirements for that payer. It is good to keep a small reference file on what the conservative therapy requirements are for each major payer in your area. You can also ask the authorization department for this information when you check on an authorization number.
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