Lecture 11: Staying Fiscally Solvent

Question 1

Get it in writing:
Get the correct ____ information.
Make the patient _______ clear to the patient.
Call the insurance company for _____ if necessary.
Send the ____ in a timely manner.

Answer 1

Billing
Responsibility
Clarification
Claims

Question 2

Billing Accurately:
Make sure your ____ ____ is up to date.
Use accurate ______ and _____ codes.
Make sure the ____ is well aware of all aspects of the ___ ___.

Answer 2

billing system
ICD-10, CPT
Biller, billing system

Question 3

When is enough information really enough?
Bill with _____ of the information.
Understand that the bill may precede the actual ____ being entered into the system at the ____ _____.
Make sure the insurance company knows “____” the patient is

Answer 3

ALL
referral, insurance company
where

Question 4

Why do you need to know when your patient is seeing another health care provider?

Answer 4

Liability reasons

If billing same CPT codes that you are, need to add modifier to allow code to be billed for

Question 5

The hardest money to collect:
Money the ___ ___.
Have patient sign ___ ___.
Patient should pay _____, _____, _____ as the charges are incurred.

Answer 5

Patient owes
Patient responsibility
Deductible, copay, coinsurance

Question 6

Getting the Money:
Give _____ _____. (Cash, credit card, check)
Have system to ______ on old accounts.
Can use an attorney or a ____ ____.
Determine the level below which you will _____ _____ payment. (Usually $___).

Answer 6

Payment alternatives
Collect
Collections agency
Not collect
300

Question 7

The Patient Statement:
Clear ____ ____.
Send bill out AT LEAST _____/_____.
For 100% patient balances, it is recommended that the statements go out ever ____-____ days.

Answer 7

Account statement
Once/month
15-20

Question 8

How long is too long?:
If patient doesn’t respond in _____ reminders, they probably won’t pay.
Don’t let account get so old that you cannot ____ ____ _____.
The quicker the bill gets to ____, the better chance it will be _____.

Answer 8

3
Find the patient
Collections, collected

Question 9

Analyze your ______.

Answer 9

Denials

Question 10

Need to track how many denials you’re getting. Some reasons:

4

Answer 10

1. Patient no longer insured
2. Claim submitted past filing date
3. No referral in place
4. You are not a provider

Question 11

Denial vs. Request for Information:
Denial has to be \_\_\_\_\_.
Request for information means claim cannot be \_\_\_\_\_ until information is received. 
- Do in a \_\_\_\_ manner.
- Follow up with \_\_\_\_ \_\_\_\_.

Answer 11

Appealed
Processed
Timely
Phone call

Question 12

Most denials cannot be appealed after _____ (time length).

Answer 12

1 year

Question 13

The Importance of the Right Staff:
Make sure staff is \_\_\_\_\_.
Follow up with staff regularly regarding \_\_\_\_\_.
Understand the \_\_\_\_\_ \_\_\_\_\_.
Stay \_\_\_\_ with changes.

Answer 13

Competent
Reimbursement
Reimbursement process
Current

Question 14

Monitoring Financial Performance:
Look for ____ from what was planned to identify potential ____.
Identify the areas where ____ and ____ become too close.

Answer 14

Deviations, problems

Income, expenses

Question 15

When determining whether to renew with an insurance company, need to consider: (2)

Answer 15

Volume lost if do not renew

Volume you would need to maintain to remain solvent