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Office Operations. Insurance Billing One Year Later Vicky Rosa MHA RN Butler University. Butler University Health Services Past. Prior to last year we had 10 hours of MD time Students/Parents wanted more MD clinical time Students/Parents/University didn’t want to pay for more MD time
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Office Operations Insurance Billing One Year Later Vicky Rosa MHA RN Butler University
Butler University Health Services Past • Prior to last year we had 10 hours of MD time • Students/Parents wanted more MD clinical time • Students/Parents/University didn’t want to pay for more MD time • Health Services was nickel and diming to get any type of revenue
So the Question was • What do the parents have that we don’t? So the Qtion was
Why did we start billing? • Ran statistics on all 2009/2010 and 2010/2011 incoming undergraduate students • Total number of charts 2,095 • 95% of students had insurance of some type • Of those 95% - 3% had the Student Health Insurance Plan • 2% showed no insurance • May not have sent copy of card • May truly not have insurance
Gallup poll May 4, 2011 • May 4, 2011 -- The percentage of young adults going without health insurance took a big drop, according to a recently released Gallup poll. • Supporters of the health care law said it's due to a provision that allows families to keep their adult children on their policies.
What about the uninsured? • People commonly ask if you can discount services to the uninsured or charge nothing at all. • Those opposed to billing typically mention that you cannot discount charges, and therefore insurance billing creates a financial barrier to care for the uninsured.
Office of Inspector General • You are free to waive a copayment if you make an individual determination that the patient cannot afford to pay or if your reasonable collection efforts fail. • It is also legal to provide free or discounted services to uninsured people. • http://oig.hhs.gov/fraud/physicianeducation/01laws.asp
Internal insurance billing • On average 32% of all claims are rejected, 5 to 15% are lost in the shuffle and never collected, • It takes a tremendous amount of employee and overhead cost to manage the entire claims filing process • The New England Journal of Medicine found that a typical doctor's overhead and billing expenses account for 43.7% of his/her gross income..
Internal billing - continued • There are a lot of hoops that doctors have to jump through to file and collect their insurance claims. • If there are any minute details on the paperwork that are not filled out correctly, the insurance company rejects the entire claim and sends it back—unpaid. Then we have to figure out what the problem is, try to fix it, re-submit the claim and hope it is right the second time around.
First there is medical coding • Medical coding is a key step in the medical billing process. • Every time a patient receives professional health care the provider must code and create a claim to be paid, whether by a commercial payer, the patient, Medicaid or Medicare.
Then there is medical billing • Medical billing is a subspecialty of medical coding. • The responsibility of the medical biller in a health care facility is to ensure that the doctors and nurses in her practice receive reimbursement for their work.
Coder ~ Biller • While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for accurately coding the claims.
Why we chose third party billing • They did the initial credentialing and continue to monitor and update • They negotiated the insurance contracts • They helped with a fee schedule • Provide training to staff (coding/billing) – which we will be needing again REAL SOON • They keep an eye out for us
Billing and Collections • They review (scrub) and submit clean claims • Track and adjudicate claims • Collect revenue • Reconcile payments • Comprehensive reporting systems
Administrative Work • FERPA HIPAA • Transactions and Code Set Polices • Security Policies • HI TECH rules • ICD 10
What would my office staff be responsible for? They will be able to continually concentrate on increasing patient care and follow up on the status of all the patients who come through our practice. With this kind of care, our patients will become great word of mouth referral sources for you.
Ready for some more fun? • The setting – HITECH laws • The year – 2013 • Life as we know it – about to change!
ICD – 10 conversion • Conversion • ICD-10 will: • Give more detailed diagnosis and treatment information, • And more accurately define services • It has been identified as a benefit
Conversion to ICD-10 • However, all of this increased specificity comes at a price. • Coders/billers salary will increase from approximately $40,000 to $60,000 annually • Codes will become more complex: • ICD-9-CM, codes are three to five digits. • The first digit is either numeric or alpha (the letters E or V only) and all other digits are numeric.
An example of ICD-9 and 10 mapping • ICD-9 to ICD-10 • Enter ICD-9 Code: 308.9 > Unspecified acute reaction to stress (no kidding this was a random pick) • Map to ICD-10 code > • F43.0 acute stress disorder or • R45.7 state of emotional shock and stress unspecified
Recipe for insurance billing • Mix up a business plan • Add discussions • Fold in research
Recipe - continued • Throw in FERPA, HIPAA, HITECH and ICD-10 • And then ask…….
Recipe • Do we decide to eat this alone ? • Or think
When it comes to HIPPA,FERPA,Security, Privacy, HITECH, EMR’s, Billing, etc • Just remember, sometimes it’s better to take the stairs than the escalator. • It may take a little longer, but it could be more fun! • http://www.youtube.com/watch?v=2lXh2n0aPyw&feature=player_embedded
