One of our providers recently moved. Those of you who have gone through this can commiserate with me.
Six hours of phone calls,faxing, and emailing later, her address was updated with the insurance companies. Mostly.
So, I am going to give you the results of our efforts in blog form and again in spreadsheet form. Yay, spreadsheets! If any of you out there have other contact info for the provider relations/ credentialing/provider demographic update departments for any other insurances, please leave a comment or shoot me a quick email.
Medicare and Medicaid require that you send them an application form to update your servicing location. If you are an individual provider, send Medicare a cms855i and if you are a group, send in a cms855b. If you don’t know whether you are an individual or a group, call provider enrollment. For Medicaid, I suggest calling your individual state Medicaid and having them direct you to the proper form. I also put the Medicare forms on the new and improved links and tools page.
The rest of the insurances simply need an updated W9 form.
Aetna – Update on Aetna.com. Here is the direct link: http://www.aetna.com/docfind/custom/provider/data_correction.html
Blue Cross – Fax W9 to (818) 234-2836, attn: Anthem Provider Database Management.
Blue Shield – Fax in a W9 to (916) 350-8860, attn: Blue Shield Provider Contracting
Caremore – Fax W9 to (562) 977-6141, Attn: Caremore
Cigna – Email attached W9 to firstname.lastname@example.org, subject line: Provider Practice Address Change
Health Net – Fax form to (877) 897-7910, Attn: Health Net PDM
IEHP – Email the provider Service Representative for your city. You will need to call them and get that info. The only one I have is for Montclair, CA and that probably won’t help most of you.
Inland Valleys IPA – Fax in your W9 to (213) 830-1815, Attn: Inland Valleys IPA
ProMed/Upland Medical Group – Even if you have more than one IPA contract with a group that ProMed administers, one fax will update everything. So, fax the W9 to (714) 667-8156, Attn: ProMed
United HealthCare – You can either fax or email the update. The email is email@example.com and the fax is (855) 314-6844
I have also included all this information in beautiful spreadsheet form. Here is the Health plan updates spreadsheet.
You’re welcome 🙂
As always, if you have any questions or anything to add, email or comment.
Your front desk staff are the marines of your office. The doctor is the general, the office manager and billers are the lieutenant and sergeants, and you can’t run a successful campaign without them. But your front desk staff are the boots on the ground, first in, last out. Their actions represent the first impression patients get of your office, and they have the last interaction with patients before those patients leave. I know that mostly, by the time you come to this blog for help, the patient has already been seen and you need to know how to get the charge paid.
But I get your emails, I know what you really need.
In a perfect world, insurances would just pay what they were supposed to, patients would send in their checks on time, and we could all leave work at 5:00. This post will help you get a little closer to that perfect world, and it all begins with your front desk. Many offices, family practice and specialists alike, end up seeing patients with insurance that is not on file, termed, or non-contracted. This happens for a variety of reasons. New patient’s tell us they have PPOs when they really come in with HMOs. Established patients forget to tell us that they changed insurance 2 months ago. HMO patients forget that if they change their PCP, they can’t come to us anymore. Howeever, with the proper procedures, the number of patients with these issues that actually get in to see the doctor can be virtually eliminated. I recently had someone contact me to train their front desk, and this is the checklist that we put together to ensure that the doctor will be paid for every service he performs.
When a patient calls in to schedule an appointment…
New patients – Many offices send patients to complete their paperwork online. If you do this in your office, you only need to get the name and phone number when the patient is on the phone.
Name and phone number
Insurance name and id#
Date of birth
We have your phone number as (909) 555-5555, is that still correct?
And we have you with BlueCross BlueShield, is that correct?
The day before the appointment….
Call to confirm appointment
If your patient filled out their paperwork online, verify eligibility
If patient has not been seen within 30 days, verify insurance (eligibility, deductible, copay)
Call to confirm appointment
Also, please be aware you have a balance of $XX.00. See you on Friday!
When the patient checks in…
We still have your address as 1122 N. Del Sol Lane, is that correct?
Collect any copay/deductible. If you are collecting toward a deductible, charge $50 and tell the patients this will be applied toward their deductible. Anything over that the insurance applies will be billed to their account. Unless the patient is in for a post-op, blood draw, or follow up for an established condition. In that case, the service the doctor performs probably won’t end up with an allowed amount of more than $50.00. We want to be very careful that we don’t charge patient’s more than the insurance allowed amount when we collect toward their deductible.
Copy any new insurance cards
When the patient leaves the office…
Schedule any necessary follow up appointment.
Collect for any additional procedures performed (cash patients)
Put in for any referrals
I have included this Front desk checklist on the links and tools page for you to download. These procedures are small changes that can have a transformative effect on your office and allow your billers to concentrate on what you pay them for. Namely, fighting with the insurance companies. When your billers have to run around after the front desk and try to solve these issues after the fact, it’s too late. As always, call or email with any questions. I love hearing from you.
This is along the lines of the cash in the office post. One of my doctors has lost an insane amount of money, and I would like you all to learn from his mistake.
I have a small Internal Med with an emphasis in Cardiology in Montclair. I go to their office once a week, after hours, and do all the charges and claims in about an hour. This isn’t bragging, they are small, and I am fast, and they only have me enter charges and send electronic claims. I have been doing their billing for four years and, until recently, I had never even seen one of their EOBs. They don’t want to pay me to post the payments, because they think it will cost them too much money.
I finally signed them up for a user name and password on the Online Provider Services Medicare website, against the office manager’s strenuous objections. On the first EOB I pull up, I immediately notice that ALL the EKGs I billed had been translating as 93005 instead if 93000. The reimbursement for a 93005 is $8.93 (allowed $11.16 minus the 20% coinsurance) and the reimbursement for the 93000 is $15.14 (allowed $18.93 less $3.79 for the coinsurance). That means my Internal Med has been losing $6.21 on every EKG for at least the last four years. He probably does 20 EKGs per week. So, ($6.21) x (20 EKGs per week) x (52 weeks) x (4 years) = $25,833.60. This does not account for the fact that over the last four years Medicare reimbursements have been decreasing.
Even after this, I have not been able to convince them that it would be more cost efficient in the long run to have me post the payments as well as the charges. Please, please, please use this as a warning and properly reconcile your EOBs with your payments. Every EOB for every charge.
Also, do it by line item and not by charge, because it is too easy to miss something important. Something like this.
P.S. If you have any questions about what you should be getting paid for things, use the Medicare Fee Schedule Look-Up. Most companies will pay a similar amount, so you are mostly safe using that as a standard.
Today we are going to play Unpleasant Truth Time. All those rules that you painstakingly memorized to get your claims out of the door are just the beginning. Insurance companies have more reasons to deny your claims then I could even begin to list here, and the biggest and most time consuming part of your job will be to unravel those reasons and get your doctor her money. This post will help you to do that. Email me at newgenerationbilling.com for the Cliff Notes version of this post.
There are two kinds of follow up–loose paper follow up and insurance aging follow up. Your loose papers are denials, partial payments, and requests for information from the insurance companies. Even with a healthy account you are going to have your share of these.
When you have denied and partially paid charges, here are your options to get them paid:
3. Appealing to the insurance company
4. Appealing to the insurance commissioner
When you resubmit a claim it is usually to correct an error. When I get a denial from an insurance company, the first thing I do is to make sure that I billed everything correctly, even though I have been doing this for over a decade now. And I make sure to check EVERYTHING. I review the diagnosis, service, date, doctor, facility, insurance, and id#, because these are all thingsI have messed up on in the past. Just a quick aside for those of you who are planning on calling us for billing or consulting services, please be assured, those mistakes are very rare. If I was the kind of person to use a smiley face in my professional blog, I would put one here.
When you do make a mistake all you have to do is correct the claim and mark in box 19 that this is a corrected claim and indicate what you fixed. Here is an example. Say you billed a DX of 627.9 (postmenopausal syndrome) to a Mr. Henry Winkler. Now, Mister Henry Winkler is not going to have postmenopausal syndrome because he is a man. You pull up the superbill and realize that you meant to bill 682.9 (cellulitis). Change your ICD9 code, in box 19 write “Corrected claim, Corrected ICD9 code”, and resubmit your claim.
Most of the denials you receive, however, will not be your fault. This is where you would call the insurance and have them reprocess the claim. Insurance companies process claims wrong all the time. Several times I have even had my claims denied as duplicates to themselves! If the claim was denied due to an error on the part of the insurance, usually all we have to do is call them and get them to send the claim back for reprocessing. Make sure you have the following information available when you call because it will save you a great deal of stress:
1. Your provider’s NPI and Tax ID. They don’t always ask for both of these, but having them in front of you when you do your follow up will save you time with those representatives that do want both numbers.
2. The patient’s ID number, name, and date of birth. They always ask for all three of these things. When you’re on the phone with an insurance company, the rep won’t hurry you, or tell you that you’re wasting her time, or ask you to hang up and call back once you have the information. But if you are scrambling around for it, you are wasting your own time.
3. The date of the charge you are calling in regards to, and total billed amount of the charge. The insurance is going to have a lot of claims on file, so they are going to need the amount of your claim to make sure the two of you are talking about the same thing.
When you request that a claim be reprocessed, please don’t take no for an answer. If the claims representative won’t help you, go up to a supervisor. Hang up and call again. Since you’ve already checked your claim top to bottom, you know that the error was not on your side and you should not have to take any more of your time to resolve this issue.
You will run across things that a phone call cannot resolve. In those cases, we send in written appeals. With my appeals I send a copy of the claim, any documentation I have to support my position, and a letter. In my letter I explain exactly what my objection is, what documentation I am attaching, and what result I expect to see. Here is a sample Appeal letter for something like a timely filing. I keep templates of my letters on file for the most common denials: timeliness, medical necessity, incorrect duplicate denials. If you want, I can post samples of those as well, just email or comment and I’ll put them up.
Now, no matter how exactly worded your letter, and no matter how thorough your documentation, sometimes your appeals will be denied. Your last resort is to go to the insurance commissioner. You can see your options on the state website http://www.insurance.ca.gov/ and there are step by step instructions on how to file your complaint.
Once all the loose papers on your desk have been taken care of, it is vital that you pull an aging report. The claims that get denied and partially paid are the claims the insurance receives. If you read the appeal letter, you probably realize that many of the outstanding claims you have on your accounts receivable right now are claims that the insurance has “never received.” The insurance will never send you a zero dollar EOB or a request for information, and your time limit to file and to appeal will run out before you realize.
Doctors, office managers, billers, please remember to pull your aging on a monthly basis. Not only will you catch the follow up that you would not otherwise find, you can make sure that your aging is healthy. A healthy aging will have at least 80% of your outstanding balances within 60 days. We have customers with 90% of the charges outstanding within 60 days.
If you pull your aging and you don’t like what you see, that is where New Generation comes in. Call us at (909) 374-5439 or email us at newgenerationbilling.com. You have plenty of options, call us and find out what the are.
Providers love it when their patients pay in cash. There is no waiting weeks, or sometimes months, for an insurance company to decide that you actually get compensated for the services you provide. Cash is easy.
Unfortunately, it is also easy to steal. This post is regretfully inspired by one of our customers. I was thinking of calling this post “If You Don’t Have a Copay Log that You Check on a Daily Basis, You are Inviting Your Employees to Steal From You.” That was really too long, though.
Doctors, office managers, please, make sure you have some written way of balancing the cash in your hand to the cash you were supposed to have received. Yes, everyone in your office should be trustworthy, and many of them are your friends, and it is very hard to imagine a friend stealing from you. But large amounts of cash are tempting for anyone.
So, here’s how it works. Every patient who pays in cash gets a receipt. Every patient who pays with a check gets a receipt. And every patient who pays with a credit card gets a receipt. The receipts come from a numbered book. Then all patients who paid money are entered on a spreadsheet that includes the date, patient name, payment amount, method of payment, and receipt number. At the end of the day, you have the exact amount of cash in your hand that you have on that spreadsheet and every patient has a sequential receipt number so that you can see no receipts have been pocketed or disposed of.
This will not stop someone who is determined to steal from you. This will enable you to catch it quickly. One of our providers has lost hundreds, if not thousands, of dollars because he did not take our advice to implement this simple procedure. And now he is facing the difficult decision of having to fire one of his friends.
Here is an example of a good Copay Log. One of my office managers has this on her computer, and she adds the patients as they check out.