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Office Operations Insurance Billing One Year Later Vicky Rosa MHA RN Butler University.

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Presentation on theme: "Office Operations Insurance Billing One Year Later Vicky Rosa MHA RN Butler University."— Presentation transcript:

1 Office Operations Insurance Billing One Year Later Vicky Rosa MHA RN Butler University

2 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

3 So the Question was So the Qtion wasSo the Qtion was What do the parents have that we don’t?

4 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

5 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.

6 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.

7 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.

8 Now the fun begins

9 Billing workflow

10 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..

11 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.

12 First there is medical coding Medical coding is a key step in the medical billing process.medical billing 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.

13 Then there is medical billing Medical billing is a subspecialty of medical coding.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. reimbursement

14 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.

15 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

16 Billing and Collections They review (scrub) and submit clean claims Track and adjudicate claims Collect revenue Reconcile payments Comprehensive reporting systems

17 Audits can be your best friend

18 Administrative Work FERPA HIPAA Transactions and Code Set Polices Security Policies HI TECH rules – ICD 10

19 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.

20 An ooh ~ ahh moment

21 Ready for some more fun? The setting – HITECH laws The year – 2013 Life as we know it – about to change!

22 Why have 17,000 ICD codes?

23 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

24 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.

25 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

26 Need I say more?

27 Sorry you can’t hide from it

28 And you can’t lose your temper because you are frustrated

29 Recipe for insurance billing Mix up a business plan Add discussions Fold in research

30 Recipe - continued Throw in FERPA, HIPAA, HITECH and ICD-10 And then ask…….

31 Recipe Do we decide to eat this alone ? Or think

32 No Worries We Have Third Party Billing


34 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! Pyw&feature=player_embedded Pyw&feature=player_embedded

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